Medical Journal of Zambia 2021-03-26T09:50:26+00:00 Dr. John S. Kachimba Open Journal Systems <p>The <em>Medical Journal of Zambia </em>is a peer-reviewed quarterly journal intended for the publication of papers from all specialities of medicine (Internal Medicine, Surgery, Paediatrics and Obstetrics &amp; Gynaecology) and their subspecialties, basic sciences, 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).</p> COVID-19 in Africa: The nuances of social distancing and handwashing 2021-03-25T15:00:22+00:00 Akwi W. Asombang Ronke Akintola-Ogunremi Kondwelani J. Mateyo Julie Mwabe Joel Kpodo Mary Ani Amponsah Filipe J.G. Monteiro Nancy Kasongo Margaret-Mary Wilson <p>The implementation of interventions to minimize the Corona Virus 2019 (COVID-19) pandemic in Africa has been flurry and increasingly complicated in nature. This milieu engenders and heightens vulnerabilities of critical masses living in socially compromised situations and economically constrained communities in the current pandemic. The increasing spread of COVID-19 has necessitated enforcement of frequent hand washing, social distancing and lockdown measures as a recommended global strategy to curb communitybased spread of the disease. However, pre-existing conditions in Africa impede capacity to observe hand hygiene, social distancing and lockdown. Although past epidemics in Africa created foundations for planning for future&nbsp; occurrences, the enormity of the current COVID-19 pandemic has overwhelmed capacity to observe globally recommended&nbsp; interventions. The rising trends in morbidity and mortality has gained attention from community members, stakeholders, regulatory bodies and governments, however, implementation of hand hygiene practices and mobility restrictions has not been in tandem with sustainable approaches that assure compliance and resource availability to limit cross-transmission. The aim of our article is to unveil current challenges with handwashing and social distancing in Africa and propose innovative solutions to prevent community-based COVID-19 transmission. The issues pertaining to Africa are not only related to the magnitude of the problem, but the unique nature of African contexts and the paucity of documented evidence that impede a re-envisioning of interventions that promote community health. Therefore, gaining an understanding of the inherent nuances is important to implementing globally recommended interventions.&nbsp;</p> <p><strong>Keywords: </strong>COVID-19, handwashing, social distancing </p> 2021-03-25T00:00:00+00:00 Copyright (c) Prevalence of Tuberculosis among bedside contacts of Smear Positive Tuberculosis Patients at The University Teaching Hospital, Lusaka, Zambia 2021-03-25T15:32:38+00:00 Patrick Lungu Duncan Chanda Gershom Chongwe Shabir Lakhi <p><strong>Background:</strong> Screening of contacts of tuberculosis (TB) patients is not routinely done in resourcelimited countries like Zambia despite the World Health Organization (WHO) recommendations, leading to missed opportunities for prevention, early diagnosis and high mortality.<br><strong>Objective</strong>: Main objective was to establish the prevalence of latent and active tuberculosis in bedside contacts of smear-positive index patients and associated risk factors.<br><strong>Methods</strong>: The study was carried at the University Teaching Hospital, a tertiary level facility. We conducted a cross sectional analytical study. We included 64 TB-unexposed and 69 TB-exposed contacts in this analysis. We recruited bedside contacts of smear-positive TB patients (TB Exposed group) in medical wards and contacts of surgical patients (TB Unexposed group) as a comparison group. A structured questionnaire was used to collect data on demographic, laboratory and clinical parameters among them being, age,&nbsp; gender, residence, relationship index patient's sputum grades BMI and HIV status. Active TB was diagnosed microbiologically and radiologically, while latent tuberculosis infection (LTBI) by tuberculin skin test (TST). Collected data was analysed using STATA 13 to determine the prevalence of TB and LTBI and the associated factors. A p value of &lt; 0.05 was considered statistically significant.<br><strong>Results:</strong> The mean age for TB unexposed and that of TB exposed was of 41.2 [±13.5] years and 40.2 [±14.7] years respectively. The Prevalence of active TB in TB exposed and in TB unexposed was 13.0% and 0% respectively. The prevalence of LTBI among TB exposed and TB unexposed was 83.1% and 38.3% respectively. Active TB in TB exposed bedside contact was associated with duration of hospital stay (AOR 2.45, 95% CI 1.0 – 5.9, p = 0.03) and index patient's sputum grade of 2+ (AOR 4.4, 95% CI 1.07 -18.3, p = 0.04).<br><strong>Conclusion</strong>: Bedside contacts of active TB patients are at an increased risk of contracting both latent and active TB. Further, our findings suggest a significant prevalence of LTBI in the general population of Lusaka. Bedside contact tracing is an effective approach to finding the missing TB patients our setting of a high TB burden country/community. The findings call for an urgent need to institute effective TB control/preventive measures with active case finding as a priority and LTBI screening finding and treatment.</p> <p><strong>Keywords</strong>: Bedside contacts, TB exposure, background exposure, active TB, LTBI.</p> 2021-03-25T00:00:00+00:00 Copyright (c) Tobacco smoking prevalent in Zambian males: Observations from the Zambia Demographic Health Survey 2013-2014 2021-03-26T07:12:39+00:00 Flavia Nalule Muyinza Pawel Olowski Charles Michelo <p><strong>Background</strong>: Tobacco smoking is one of the biggest public health threats causing poverty, several illnesses and death. Previous studies found that the lower the education, the higher the risk of smoking. This study assessed the association between education attainment and smoking among participants of the Zambia Demographic Health Survey 2013-2014.<br><strong>Methodology</strong>: This was a population-based crosssectional study. Secondary data was extracted from existing Zambia Demographic Health Survey 2013-2014 data sets, from ten provinces in comparison with different variables to constitute a resultant data set which this study used. All successfully interviewed male and female participants who answered the question, “Do you currently smoke cigarettes?” or “Do you currently smoke or use any other type of tobacco?” were included. The data extraction form was used to extract values of dependent and independent variables and imported into statistical analysis tool Stata version 13. Descriptive statistics of individual characteristics, testing for associations using the Pearson's Chi Square test and logistic regression were&nbsp; performed.<br><strong>Results</strong>: Overall there were 14773 men and 16411women with mean age of 15-19. Smoking prevalence was 9.9% overall and 20.4% in men, but 0.5% in women. The incidence of tobacco smoking is steadily increasing with increase in age among both men and women. There was a significant increase in the incidence of smoking between 20-24 and 25-29 particularly in male smokers. Higher socioeconomic status seems to have a protective effect, consequently smoking remains highest among poor individuals and lowest among the rich. Higher education groups had a decreased likelihood to smoke with an odds ratio of 0.5 overall, 0.2 in men and 0.1 in women.<br><strong>Conclusions:</strong> We report high and unchanging prevalence of smoking predominantly concentrated in rural adult populations with lower education attainment. This suggests past health promotion efforts that targeted whole population may not have been relevant to the most affected groups. This therefore calls for reshaping health promotion messages to target specific populations and settings<br>with highest burden. Furthermore, this calls for additional explorative studies in order to examine reasons for smoking in lower&nbsp; educated groups including exploring how what has worked in reducing smoking in higher educated groups could be extrapolated to most affected low educated and rural populations </p> <p><strong>Keywords</strong>: Smoking; Education; Prevalence; Determinants; Patterns; ZD</p> 2021-03-26T00:00:00+00:00 Copyright (c) Feasibility and Safety of Prosthetic Implants for Inguinal Hernia Repair in a Nigerian Tertiary Hospital 2021-03-26T07:46:25+00:00 Aloysius Ogbuanya Fabian Olisa Amobi Oguonu Nonyelum Ugwu <p><strong>Background:</strong> Worldwide, inguinal hernia repair is the commonest surgical procedure in general surgery, but the optimal repair technique for inguinal hernia has not been defined and accepted in most parts of Africa and other developing nations. The aim of this study was to determine the epidemiology of inguinal hernias and feasibility of mesh implants in our centre.<br><strong>Methodology</strong>: This was a descriptive crosssectional study of consecutive adult patients with uncomplicated inguinal hernias who received polypropylene mesh for repair of their inguinal hernias. Selection criteria included inguinoscrotal/ inguinolabial hernia, recurrent or bilateral hernia or bubunoceles with wide defects. Descriptive statistics and tests of significance were done.<br><strong>Results</strong>: Inguinal hernia represented 77.3% of all abdominal wall hernias encountered during the study. However, only 27.8% (100 patients) of the 360 patients that satisfied the inclusion criteria received mesh implants. Of the 100 patients studied, 31% had recurrent hernias, 48% harbored complete inguinoscrotal/inguinolabial hernia while 13% had incomplete inguinoscrotal hernia. Majority (86%) had unilateral hernia. The annual repair rates using mesh implants increased progressively from 4% in 2013 to 40% in 2017. A quarter (25%) had comorbidities. Majority (60%) of repairs were under general anesthesia. The overall postoperative complication rate was 14%. Wound infection rate was 3.5%. There was statistically significant difference in the rates of wound-related events between recurrent and primary inguinal hernias (p=0.000). There was no mortality or recurrence recorded in this study.<br><strong>Conclusion</strong>: The uptake of mesh implants for inguinal hernia repair in our environment is low, though the trend is changing with higher proportions of patients accepting mesh implants in recent time. Elective inguinal hernia surgery with polypropylene<br>mesh is feasible, safe, effective and reproducible in our setting. </p> <p><strong>Keywords:</strong> Inguinal hernia, implant, morbidity, implant, recurrent.</p> <p>&nbsp;</p> 2021-03-26T00:00:00+00:00 Copyright (c) Psychosocial Impact of Dental Aesthetics among Secondary School Students in Birnin Kebbi, Northern Nigeria: Population-Based Study 2021-03-26T07:55:13+00:00 Kehinde Kazeem Kanmodi Njideka Jacob Nwafor Linda Ekele Iyadi Babatunde Abiodun Amoo Kelechi Israel Eddah Semeeh Akinwale Omoleke <p><strong>Introduction</strong>: Dental aesthetics is a major determinant of good psychosocial well-being. Individuals with good dental aesthetic&nbsp; appearance tend to enjoy better social interactions and quality of life than those with poor dental aesthetic appearance. This study aims to assess the psychosocial impact of dental aesthetics among secondary school students in Birnin Kebbi metropolis, Kebbi State, Northern Nigeria.</p> <p><strong>Material and Methods:</strong> This study was a questionnaire-based cross-sectional survey of 692 students attending Army Day Boys&nbsp; Secondary School (ADBSS) and Army Day Girls Secondary School (ADGSS), Birnin Kebbi. Data collected was analysed using SPSS version 20 software.</p> <p><strong>Results:</strong> The majority (75.4%) of the 692 respondents were within the age range of 15 – 19 years of age, 50.7% were in SS 1 class, and&nbsp; 53.7% were females. The majority (&gt;82%) of the respondents were confident about the appearance of their dentition, roughly half of the respondents were negatively impacted, socially, by the appearance of their dentition. There exists a statistically significant relationship between respondents' gender and: psychosocial self-perception of their dental aesthetics (p-values&lt;0.05); and concerns about their dental aesthetics (p-values&lt;0.05).</p> <p><strong>Conclusion</strong>: This study concluded that many of the surveyed northern Nigeria secondary school students were not convenient with&nbsp; their current dental aesthetic appearances. Appropriate counselling, public health, and clinical intervention programmes may go a&nbsp; very long way in minimizing the negative impact of dental aesthetics-associated psychosocial problems among this population group</p> <p><strong>Keywords</strong>: Psychosocial impact, oral health, dental aesthetics, students, Nigeria </p> 2021-03-26T00:00:00+00:00 Copyright (c) Road traffic injuries among children in Dakar, Senegal 2021-03-26T08:04:50+00:00 Azhar Salim Mohamed Pape Alassane Mbayea Mbaye Fall Aloise Sagna Ndeye Aby Ndoye Alou Diaby Fatima Diallo Oumar Ndour Gabriel Ngom <p><strong>Background</strong>: Road traffic injuries (RTI) are a major public health problem and contribute significantly to the global burden. The aim of this study was to assess the frequency of RTIs in children and to determine their socio-demographic and lesional characteristics.<br><strong>Patients and methods:</strong> This was a retrospective and descriptive study over a two-year period from January 2015 to December 2016 conducted at the Department of Paediatric Surgery at the Aristide Le Dantec Hospital in Dakar. Included were all children under the age of 16 victims of a RTI. We studied various parameters relating to the victims (sex, age, education) and the accident (location and<br>time of occurrence of the accident, circumstances and mechanism, duration of admission to the emergency unit, localization and type of lesion). The data was entered and processed using Microsoft Office Word and Excel 2010 software.<br><strong>Results</strong>:Among the 425 cases received, 62.6% were boys and 37.4% girls. The average age of the children was 7.7 years. RTIs occurred mainly in pedestrian (63.8%) who wanted to cross the road. There were more accidents in the city-center area (64.9%) and during afternoons (61%). Lesions of the soft parts (wounds, contusion and decay) were predominated (89.6%) followed by fractures. The<br>upper limbs were the main locations of trauma.<br><strong>Conclusion</strong>: RTIs are common among children in Dakar. Boys crossing roads are the largest number of victims. Soft tissue trauma predominates and is mainly found on the thoracic limbs. </p> <p><strong>Keywords</strong>: Road traffic injury; Boys; Lesions of the soft parts; Dakar</p> 2021-03-26T00:00:00+00:00 Copyright (c) Mental Health and Healthcare Provision in Zambian Correctional Facilities 2021-03-26T08:13:38+00:00 Jonathan Chinyama Anitha J. Menon <p><strong>Objective</strong>: The aim was to determine the prevalence of psychiatric disorders, mental health problems and mental health care service provisions in Zambian correctional facilities<br><strong>Study sample</strong>: 240 inmates interviewed using the MINI, the WEMWBS and demographic questionnaire<br><strong>Research Design</strong>: This was a cross-section point prevalence<br><strong>Results:</strong> Prevalence rates: Current psychiatric disorders 46.2%. Current and past 63.3%. Major depressive episode 47(19.6%), Psychotic disorder current 38(15.8%), Psychotic disorder lifetime 18(7.5%), Major depressive episode past 17(7%), Substance dependence current and Posttraumatic disorder 14(5.8%) each, Manic episode current 5(2.1%) and the rest below 2%. Suicide risks had 49 inmates out of 240(20.4%). Out of 49, 20(40.8%) had high- risk, 8(16.3%) moderate and 21(42.9%) low risk- levels. Medium had the highest prevalence<br>of inmates at risk of suicide 31(63.3%). Out of 31, 17(54.8%) had low, 6(19.4%) moderate and 8(25.8%) high-risk levels. Second highest was maximum 18(20%): out of 18, 4(22.2%) had low, 2(11.1%) had moderate and 12(66.7%) high- risk levels. Inmates in maximum correctional facility were more likely to have suicidal ideations and attempts than their counterparts in medium. Substance dependence is higher in medium (11%) compared to maximum (3%) and current substance abuse at 2% in both and 1% current alcohol abuse in medium. Mental Well-being WEMWBS mean score (cut-off point) at 50.7, Minimum (50.7) showed good and stable mental Wellbeing compared to Medium and Maximum whose participants recorded poor mental Wellbeing 36.2 and 37.4.<br><strong>Conclusion:</strong> There is a high prevalence of psychiatric disorders and mental health problems with total absence of mental health care services among inmates in the three Zambian correctional facility categories. Majority of these inmates are not screened and treated. Greater mental health awareness and provision of mental health services focusing on staff training programmes to detect mental illnesses are needed and further research is recommended throughout Zambia.</p> <p><strong>Keywords</strong>: Mental health; psychiatric disorder; prevalence; correctional facility; inmate; Zambia</p> 2021-03-26T00:00:00+00:00 Copyright (c) Incorporating “ICT” Training into Undergraduate Medical Curriculum: An Online Survey assessing the opinions of Medical Students 2021-03-26T08:35:37+00:00 Oghosa Evbuomwan Kehinde Kazeem Kanmodi Njideka Jacob Nwafor Emma Omoruyi Dabota Yvonne Buowari <p><strong>Background:</strong> The huge relevance of Information and Communications Technology (ICT) in healthcare cannot be overemphasized.&nbsp; Despite the huge benefits associated with the use of ICT in healthcare, many medical schools (especially in the developing countries) are yet to incorporate ICT education as an academic course in their school curricula. This study aims to assess the opinions of medical students on the incorporation of ICT as an academic course into undergraduate medical curriculum.<br><strong>Material and Methods</strong>: This study was a crosssectional online survey of 135 Nigerians who were studying Human Medicine as at the time of the survey. Study data was collected using an equestionnaire which explored the participants': level of academic exposure to ICT education, usage of digital health products, perception of the relevance of digital technologies in healthcare, and opinions on<br>the incorporation of ICT into undergraduate medical curriculum. Collected data was analyzed using SPSS version 23 software.<br><strong>Results</strong>: Majority of the respondents were from developing countries (95.6%), 71.1% were 21 – 25 years old, 63.7% were females, and&nbsp; 47.4% were final year students. Not up to one-third (28.1%) of them had ever taken a course (or obtained a degree) that is related to ICT, 5.9% did not consider digital health technologies to be of relevance to healthcare, 91.1% were of the opinion that the future of<br>healthcare is digital, 87.4% were enthusiastic about using and/or promoting digital health strategies, 60.7% had used digital health product in their lifetime, and 94.8% were of the opinion that medical schools should have ICT courses in their curriculum. However, there exists no statistically significant difference between the opinions of the respondents on the incorporation of ICT into medical curriculum and their: gender, age, country of residence, location of school, and academic level (p-values&gt;0.05).<br><strong>Conclusion</strong>: Many of the surveyed medical students lack basic training on ICTdespite their high rate of lifetime use of digital health products. Despite this, many of them are in favor of the incorporation of ICT as an academic course into the medical school curriculum. </p> <p><strong>Keywords</strong>: Information and Communications Technology, medical students, digital health, curriculum, education, opinions </p> 2021-03-26T00:00:00+00:00 Copyright (c) Interventional Treatment of Symptomatic Uterine Fibroid by Uterine Artery Embolisation at the University Teaching Hospital in Lusaka, Zambia 2021-03-26T08:50:48+00:00 Liu Yiqiang Veronica Sunkutu- Sichizya Fu Huimin Mutinta Siachami Nteeni <p><strong>Objective</strong>: To investigate the clinical effect of interventional therapy for symptomatic uterine fibroid by transcatheter uterine artery embolisation.</p> <p><strong>Methods</strong>: Sixteen patients of symptomatic uterine fibroids were treated with selective uterine artery embolisation, and the relief of&nbsp; symptoms and reduction of fibroids were observed.</p> <p><strong>Results</strong>: Bilateral uterine artery embolisation was done in 16 patients. Follow-up for 5 ~ 7 months showed that the clinical symptoms&nbsp; of 14 patients were obviously improved, and the re-examination of 1 patient of a very large myoma showed no obvious change after 6 months. B-Ultrasound showed that the size of the tumor was reduced by 43% ~ 92%. The major complication was being is&nbsp; postoperative lower abdominal pain.</p> <p><strong>Conclusion</strong>: Uterine artery embolisation is a safe and effective method to treat uterine fibroid. </p> <p><strong>Keywords</strong>: Uterine Fibroid; Embolism; Uterine Artery</p> 2021-03-26T00:00:00+00:00 Copyright (c) Medical School Admissions: A Review of Global Practices, Predictive Validity, and Practice Points for Africa 2021-03-26T09:20:06+00:00 Christian C. Ezeala Mercy O. Ezeala Vaseem Shaikh Tumelo M. Akapelwa Sam B. Phiri John A. Mulemena Festus Mushabat Kingsley Kamvuma Warren Chanda Gibson Sijumbila <p><strong>Background:</strong> Processes for selection of candidates into medical schools vary globally. Knowledge of the predictive validity of a selection method is important for policy revision.</p> <p><strong>Aim:</strong> To survey the practices used by medical schools to select students and their predictive validity.</p> <p><strong>Methods</strong>: Search terms developed from the research problem were used to search Google Scholar, PubMed, and Educational Resources Information Centre (ERIC). These were “medical school,” “predictive validity,” “success,” “academic achievement” “admission criteria,” and “student selection.” Retrieved articles were screened for relevance and sorted according to countries of<br>publication. Authors narratively reviewed the articles from each country and collated the findings. Best practices were recommended for African-based medical schools.</p> <p><strong>Results</strong>: Articles retrieved from 14 countries were included in the review. USA, Canada, UK, Australia, and New Zealand operate&nbsp; centralized medical school admission programs and administer nationwide admission tests. These tests cover cognitive and non-cognitive domains. The validity of these tests in predicting medical school success were extensively studied and reported. Other countries do not operate centralized medical school admission programs. Most of these rely on cognitive excellence to select students. Few reports are available on the validity of selection practices in Africa. Most rely on cognitive excellence which highly predicted academic success during preclinical studies. Predictivity decreased during clinical phases and non-cognitive variables&nbsp; became better predictors of success.</p> <p><strong>Conclusion:</strong> Medical school admission processes should consider cognitive and non-cognitive factors. With non-cognitive factors,&nbsp; candidates with right attitudes are selected. African countries should align their practices to that of Western countries.</p> <p><strong>Keywords</strong>: Admission, undergraduate medical education, predictive value of tests, selection criteria, educational achievement</p> 2021-03-26T00:00:00+00:00 Copyright (c) The Practice of Clinical Social Work in Namibia: A Review of Literature 2021-03-26T09:34:54+00:00 Mwakanyadzeni Abigail Chipare Tracy Mupazvihwo Roy Tapera James January <p>No Abstract.</p> 2021-03-26T00:00:00+00:00 Copyright (c) Evolution of spontaneous dissecting mycotic Superior Mesenteric aneurysm in a 12-year-old child: A case report 2021-03-26T09:39:32+00:00 Mulewa Mulenga Bruce Bvulani Adrian Maleya <p>Visceral artery aneurysms are uncommon especially in children. One of the main complications before surgery is rupture. This 12-year-old child presented with a large, fast growing, mycotic superior mesenteric aneurysm that had all the favourable conditions for rupture. There was spontaneous dissection of the weakened media with partial erosion of the aneurysm into the wall of the third part of the duodenum. However, this aneurysm formed a thrombus that gradually occluded the lumen. This led to formation of collateral vessels for the continued vascular supply of the midgut. The uniqueness of this case report has been highlighted from several points (the rarity of the condition in children, the favorability of the conditions to rupture, the gradual but complete luminal occlusion with the eventual formation of collaterals to supply the midgut, and the spontaneous medial dissection with partial duodenal wall erosion without causing rupture). Although there is no standard surgical approach, early elective surgery is recommended. Nonoperative&nbsp; approach is an option that should aim at reducing the risk for rupture. Control of blood pressure is key. This child underwent surgery. Under total vascular exclusion, the aneurysm was opened. After total luminal occlusion and collateral blood supply to midgut was noted, infected thrombus was evacuated and the aneurysm walls debrided. </p> <p><strong>Keywords</strong>: Superior mesenteric artery, visceral artery aneurysm, aneurysm, midgut.</p> 2021-03-26T00:00:00+00:00 Copyright (c) Severe Conjunctival Papilloma in a Six year old female - Case report 2021-03-26T09:49:10+00:00 George N. Chipeta Kangwa I.M. Muma <p>Conjunctival papilloma is a benign growth arising from the stratified squamous epithelium of the conjunctiva. It is mostly a self-limiting growth. Conjunctival papilloma occurs commonly in male adults especially in their third and fourth decades of life. It rarely occurs in children. This is a case report of a six (6) year-old female patient who was seen at the Solwezi General Hospital Eye Clinic&nbsp; (SGHEC) with complaints of difficulties in seeing, sandy sensation and tearing of the right eye. The patient had a twelve-month history of multiple fleshy growths on the conjunctival surface of the right eye, referred from a rural health centre in the District. A clinical diagnosis of conjunctival papilloma was made at SGHEC and the child was referred to Kitwe Teaching Eye Hospitals (KTEH) for further<br>management. At Kitwe Teaching Eye Hospital, a successful excisional biopsy of the conjunctival papilloma lesions on the right eye was conducted with adjunctive therapy of Mitomycin-C intraoperatively, and topical chemotherapy of 5- fluorouracil (5-FU) after surgery. A definitive diagnosis of Benign Conjunctival Papilloma was confirmed for the patient's condition, based on the results from the&nbsp; histopathology samples that were sent to the Cancer Disease Hospital in Lusaka. </p> 2021-03-26T00:00:00+00:00 Copyright (c)