Medical Journal of Zambia https://www.ajol.info/index.php/mjz <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> Zambia Medical Association en-US Medical Journal of Zambia 0047-651X It is condition of in the journal that the authors assign copyright to the "Medical Journal of Zambia". To this effect all accompanying letters must contain the following statement: “The authors being the sole and legitimate holder of the copyright hereby transfer it to the Medical Journal of Zambia. The hidden monster of domestic violence during the COVID-19 pandemic in resource limited settings: a call to action https://www.ajol.info/index.php/mjz/article/view/206229 <p>No Abstract.</p> Mwakanyadzeni Abigail Chipare Copyright (c) 2021-04-22 2021-04-22 48 1 1 3 Vision Screening of Learners by Teachers in Kafue District in Zambia as a Strategy to Address the Challenges of Childhood Blindness https://www.ajol.info/index.php/mjz/article/view/206230 <p><strong>Background</strong>: Early detection and treatment of eye diseases in children is critical in combating childhood blindness. Innovative community-based strategies such as training of teachers in vision screening need to be developed for effective utilisation of the available human resources as well as to counter the challenges of inequitable distribution of trained eye health human resources<br>as well as the limited access of quality eye health care services to the majority of our population.</p> <p><strong>Aim</strong>: To evaluate the effectiveness of using teachers as the first level of vision screeners.<br><strong>Materials and Methods</strong>: Teacher training programmes were conducted for schoolteachers to educate them about childhood eye diseases and the significance of their early detection. The teachers trained for the school vision screening were from all government, private and community schools located in Kafue District. The teachers then conducted vision screening of learners in their schools.<br>Subsequently, the mobile eye health teams visited the schools for the re-evaluation of learners identified with poor vision. All learners identified with refractive errors had refraction performed on them and spectacles prescribed. The mobile eye health teams referred learners requiring a further ophthalmic evaluation to the University Teaching Hospitals – Eye Hospital which was the base hospital for the programme. The assessment included calculation of true positives, false positives, true negatives and false negatives.<br><strong>Results</strong>: One hundred and fifty-four (154) teachers from 73 primary and secondary schools underwent training in vision screening. The teachers screened 18,713 learners and reported eye diseases in 2,818 (15.1%) children. However, the mobile eye health teams examined 5,958 learners who included 2,818 referrals from teachers and 3,140 rescreened learners. The mobile eye health teams confirmed eye problems in 2,818 learners screened by the teachers and further diagnosed more eye problems in 999 learners giving a total of 3,817 learners with eye problems. Thus, the teachers were able to correctly identify eye problems (true positives) in 100.0% (2,818/2,818) of learners. The teachers could not identify eye problems in 999 learners giving false negatives were 26.2% (999/3,817).<br><strong>Conclusion</strong>: Considering the high true positive value and the comprehensive coverage provided by the survey, vision screening in schools by teachers is an effective method of identifying learners with eye problems and poor vision early. This strategy could be valuable in reducing the workload of the eye health care staff.</p> <p><strong>Keywords</strong>: Vision screening, true positives, false negatives, screening, predictive value, childhood blindness</p> Kangwa I.M. Muma Grace Chipalo-Mutati Judith Munthali Teddy Chibwe Evans Ngalande Kenneth Siputuma Exhildah Phiri Mutale Nyaywa Godfrey Mwelwa Anne Buglass Chileshe Mboni Copyright (c) 2021-04-22 2021-04-22 48 1 4 14 Success of Aetoxiscerolin the Treatment of Medically Refractory Rectal Mucous Prolapse among Children at the Hospital Aristide Le Dantec in Dakar, Senegal https://www.ajol.info/index.php/mjz/article/view/206231 <p>No Abstract.</p> M. Fall E. Bitchoka M. Mboup F. Lo As Mohamed P.A. Mbaye O. Ndour G. Ngom Copyright (c) 2021-04-22 2021-04-22 48 1 15 18 Effects of Supportive Group Therapy on Levels of Hopelessness in Patients with Cervical Cancer at Cancer Diseases Hospital in Lusaka, Zambia https://www.ajol.info/index.php/mjz/article/view/206232 <p><strong>Background</strong>: Hopelessness is a subjective appraisal of negative expectations about the occurrence of a highly valued outcome coupled with the sense that one lacks control over desired events in the future. Hopelessness is an early symptom of depression and is comorbid with cervical cancer. Supportive Group therapy offers an economical and time efficient solution. In Zambia and particularly at Cancer Disease Hospital such structured supportive group therapy is not being offered. This study aims to ascertain whether supportive group therapy can reduce levels of hopelessness in cervical cancer patients at Cancer disease hospital in Lusaka Zambia.<br><strong>Methodology</strong>: This was a double blinded Randomized Controlled Trial conducted at Cancer Disease Hospital in Lusaka Zambia. It was<br>conducted between March 2019 and September 2020. Patients with histologically confirmed diagnosis of cervical cancer were recruited. Sociodemographic characteristics and clinical presentations were elicited by detailed history taking and file review. All the participants completed PreHAI Questionnaire and their results were noted. They were then divided into a control and intervention group using computer generated numbers. The intervention group then attended one hour Supportive group therapy sessions weekly for four weeks. The control group continued to receive the usual support of their family members and Cancer disease hospital staff. Both&nbsp; groups were then administered the Post- HAI Questionnaire and their results were noted.<br><strong>Results:</strong> 49 patients were recruited. Patient retention was 92% (n= 45). Majority of the participants were of the age group 41-50 years i.e. control group (n =12) intervention group (n= 7). Majority were; married control (n= 11) intervention (n= 12), unemployed control (n=14) intervention (n= 18), had social support control (n=14) intervention (n= 18). Only social support correlated with lower HAI scores (p= 0.047). There was no correlation between therapy and post HAI scores as both p- values i.e. control (p= 0.683) intervention (p= 0.368) were greater than confidence interval 0.05. The intervention group had a greater reduction in HAI scores from (p= 0.621 to p= 0.368) in comparison to the control group (p= 0.707 to p= 0.683).<br><strong>Conclusion:</strong> There was a difference (yet statistically insignificant) in treatment outcomes of cervical cancer patients receiving&nbsp; supportive group therapy to those not receiving supportive group therapy. That is to say that the intervention group showed a greater reduction in HAI scores in comparison to the control group. Social support is the only significant factor associated with lower levels of hopelessness.</p> <p><strong>Keywords:</strong> Hopelessness, Hopelessness assessment in illness questionnaire (HAI), Cervical cancer, Supportive group therapy</p> Christine Mutelo Ravi Paul Joyce Ncheka Copyright (c) 2021-04-22 2021-04-22 48 1 19 24 A Survey of Medical Students' Experiences with Online Practical Pharmacology Classes during Covid19 Lockdown https://www.ajol.info/index.php/mjz/article/view/206233 <p><strong>Background:</strong> Due to Covid-19 restrictions, medical education now embraces online teaching. Aim: To determined medical students' perception of online pharmacology practical classes conducted during COVID-19 lockdown.<br><strong>Methods</strong>: Years 2 and 3 students participated in the study. Before the pandemic, they used the exercises for on-site classes. They used Cyber Patient, Organ bath, Virtual Cat, and Virtual Rat software to conduct pharmacokinetics, pharmacodynamics, autonomic,&nbsp; cardiovascular, and neuropharmacology exercises. Through Moodle, they received instructions and resources; and the tutors accessed<br>and rated their reports. To determine their readiness and perception of the exercises, the study conducted a cross-sectional survey using a questionnaire that included a demographic section, a section on ICT readiness, and a section on perception of the exercises. Statistical analysis included mean scores, t-test, Cronbach's coefficient, and principal components.<br><strong>Results</strong>: Sample size for both classes (total enrolment = 191) was 128. Seventy-eight students participated (45 from year 2 and 33 from year 3). Response rate was 60.94 %, mean age 21.7 (SD = 4.0); 74.4 % had no formal ICT training, 92.3 % had personal computers, 95 % used computers often, and 79.5 % required ICT training. Cronbach's coefficient was 0.8, and factor analysis yielded two principal<br>components that accounted for 54.5 % of the variance. The participants were “satisfied” with the exercises, reported that these&nbsp; programs were “quite user-friendly,” “somewhat-easy” to use, and “supportive” of learning. They would “likely” recommend them for future use.<br><strong>Conclusion</strong>: The online exercises provided an effective method of delivering practical pharmacology classes to medical students.</p> <p><strong>Keywords</strong>: Computer simulations; Covid-19; medical students; online learning; pharmacology; social isolation</p> Christian Chinyere Ezeala Mercy Okwudili Ezeala Tumelo Muyenga Akapelwa Copyright (c) 2021-04-22 2021-04-22 48 1 25 30 Medical students' knowledge on the use of ionising radiation during medical imaging procedures in Zambia https://www.ajol.info/index.php/mjz/article/view/206234 <p><strong>Purpose</strong>: This study aimed to explore and describe the medical students' knowledge on the use of ionising radiation and its harmful effects during diagnostic imaging procedures in Zambia.<br><strong>Methods</strong>: A quantitative cross-sectional design was employed. A census survey of all final year medical students from the University of Zambia (UNZA) was conducted. Data was collected using a structured questionnaire and analysed using STATA version 13 and Graph Pad Prism 5.<br><strong>Result:</strong> The overall results revealed that medical students had inadequate knowledge of the use of ionising radiation. Furthermore, most of the students revealed that the medical school curriculum was inadequate in equipping them with the necessary knowledge required for them to request diagnostic medical imaging procedures utilizing ionizing radiation.<br><strong>Discussion:</strong> The results implied that the knowledge levels of the medical students were insufficient in the use and prescription of imaging procedures. It is suggested that the UNZAmedical school curriculum is critically scrutinized and a radiation protection course is included. The inclusion would provide the medical students with the necessary knowledge about ionising radiation in order to prevent unnecessary referrals for diagnostic medical imaging procedures.</p> <p><strong>Keywords</strong>: Ionising radiation, Knowledge, Medical students, Radiation protection</p> Boster Dearson Siwila Lucky N.R. Chipeya Sibusiso Mdletshe James Maimbo Sichone Copyright (c) 2021-04-22 2021-04-22 48 1 31 31 Causes of Reject and Repeat of Digital Radiographic Images: A Literature Review to Guide the Practice of Radiography in Zambia https://www.ajol.info/index.php/mjz/article/view/206235 <p><strong>Background</strong>: Radiographers aim at always improving the quality of imaging services through the production of high-quality diagnostic images, whilst minimising the radiation doses to patients and reducing healthcare costs. One strategy used in achieving this is conducting periodical reject and repeat image analysis.<br><strong>Objective</strong>: The aim of this study was to review the causes of rejection and repetition of digital radiographic images to guide the practice of radiography in Zambia.<br><strong>Methods</strong>: A literature search was conducted in January 2021 in PubMed/MEDLINE and ScienceDirect electronic databases. The search was extended to reference lists of eligible articles and radiography journals.<br><strong>Results:</strong> Seven research studies and clinical audits were identified to be relevant and included in this review. Six causes of rejection and repetition of digital radiographic images were identified: patient positioning errors, inappropriate selection of technical exposure factors, patient motion, presence of artefacts, improper collimation of the radiographic beam, and absence of permanent anatomical side markers (ASM). Amongst these factors, patient positioning error was the most common reason for rejecting and repeating digital<br>images.<br><strong>Conclusion</strong>: The review found the overall image rejection rate to be within the acceptable range in digital radiography. This review's findings can guide the practice of radiography in Zambia as the transition takes place from traditional film-based radiography to digital radiography (DR) imaging systems.</p> <p><strong>Keywords</strong>: Digital radiography, Radiographic image, Radiographer, Reject analysis </p> Osward Bwanga Copyright (c) 2021-04-22 2021-04-22 48 1 38 45 Impact and challenges of consultancy role regarding the delivery of breast imaging services in the United Kingdom: consultant breast radiographers' perspective https://www.ajol.info/index.php/mjz/article/view/206236 <p><strong>Background:</strong> Breast cancer is the leading cause of death in women worldwide. Imaging and radiographers play an important role in the diagnosis and treatment of breast cancer. With the increase in demand and a shortage of radiologists in the UK, consultant breast radiographers were introduced to perform some roles previously performed by radiologists. However, there is a scarcity of research<br>to assist other countries, such as Zambia, who are planning to extend the role of radiographers.<br><strong>Objective</strong>: To explore the impact and challenges of the radiography consultancy role regarding the delivery of breast imaging services in the United Kingdom.<br><strong>Methods</strong>: The study was guided by a qualitative research design. The sample was purposively selected, and semi-structured interviews was used to collect data from consultant breast radiographers in the UK. Data saturation was reached after interviewing eight&nbsp; participants. Interviews were audio-recorded, transcribed and data analysed thematically.<br><strong>Results</strong>:Two themes were identified: the impact and challenges of the radiography consultancy role regarding the delivery of imaging breast services. The creation of consultant posts impacted positively on the service delivery: reduction in patient waiting times, career progression and job satisfaction, and reduction in the workload of radiologists. Participants also faced challenges: increased workload and time pressure, isolation and poor support from colleagues, and animosity from a few radiologists.<br><strong>Conclusion</strong>: It is evident that consultant breast radiographers have contributed greatly to improved healthcare delivery. However, consultant breast radiographers encounter challenges in their role as consultants. Radiographers undertaking new roles should be supported to improve the delivery of imaging services.</p> <p><strong>Keywords</strong>: breast cancer, consultant radiographer, imaging, radiologist, role extension</p> Nachalwe Chipampe Mercy Osward Bwanga Copyright (c) 2021-04-22 2021-04-22 48 1 46 53 Hematometrocolpos secondary to distal vaginal obstruction following childbirth: A Case Report from Monze Mission Hospital, Monze, Zambia https://www.ajol.info/index.php/mjz/article/view/206237 <p>Vaginal outlet obstruction commonly occurs with congenital anomalies resulting in accumulation of menstrual blood in the vagina or both vagina and uterine cavity. Childbirth injuries such as cervical, vaginal and perineal lacerations as well as episiotomies are common and may result in complications like vaginal stenosis and excessive perineal scarring. Reported here is a rare case of complete occlusion of the vaginal introitus secondary to a badly healed injury resulting from childbirth.</p> <p><strong>Keywords</strong>: Episiotomy, Hematocolpos, Hematometrocolpos.</p> Eugine Kaunda Copyright (c) 2021-04-22 2021-04-22 48 1 54 57 The use of Neurobion Forte in the Treatment of Pellagra in an adult on anti-TB treatment: A case report from Lusaka, Zambia https://www.ajol.info/index.php/mjz/article/view/206238 <p>The deficiency of Niacin and/or its precursor amino acid, Tryptophan can result in a disease called Pellagra. Isoniazid (INH), a key drug used in tuberculosis (TB) treatment has been associated with pellagra particularly in developing nations where poor nutritional status is highly prevalent among its people.We report a case of pellagra with classical dermatological manifestations (hyperpigmented skin lesions around the neck), on the face, and external surfaces of the upper limbs) in a black African HIV negative adult female, on TB treatment for 11 weeks managed with a combo of Vitamin B1 - 10mg, Vitamin B2 - 10mg, Vitamin B3 - 45mg, Vitamin B5 - 50mg, Vitamin B6 - 3mg and ® Vitamin B12 - 15mcg (Neurobion Forte) with noticeable response to the treatment within one week.</p> <p>Keywords: Pellagra, Isoniazid, Niacin, Vitamins B1, B2, B3, B6 and B12,&nbsp; Neurobion<sup> ®</sup> Forte.</p> Sarah Nyangu Mary Kagujje Patrick Lungu Kevin. M. Zimba Lophina Chilukutu Monde Muyoyeta Copyright (c) 2021-04-22 2021-04-22 48 1 58 62 A Case Report of Tenofovir Alafenamide Induced Alopecia in a Zambian Teenager: A call for Pharmacovigilance https://www.ajol.info/index.php/mjz/article/view/206239 <p>Adverse drug reactions continue to pose a global risk in the fight against HIV. In an attempt to attain the end AIDS pandemic by 2030, newer drugs are being formulated with better efficacy and fewer side effects. However, these new drugs still have Adverse Drug Reactions (ADRs), which may affect adherence and compliance. We present a rare case of Tenofovir Alafenamide (TAF) induced alopecia of a&nbsp; Zambian teenager in the context of pharmacovigilance as a tool to identify ADRs, which may or may not have been identified during clinical trials. This is a wake-up call to all health care workers to identify and report ADRs and use the established channels to affect policy change.</p> <p><strong>Key words:</strong> Tenofovir Alafenamide, Alopecia, Adverse Drug Reactions, pharmacovigilance, PLWHIV</p> Benedict Moonga M. Jean Mukumbuta Malan Malumani Copyright (c) 2021-04-22 2021-04-22 48 1 63 66 The psychological impact of snakebite, a neglected aspect in WHO snakebite treatment guidelines for Africa: Lesson learnt from a historical case report from Zambia https://www.ajol.info/index.php/mjz/article/view/206240 <p>From a historical case of systemic envenoming and depression in Zambia details were kept. Presenting features fitted a viper bite,&nbsp; warranting polyvalent antivenom intravenously. Applying presently used 'WHO guidelines for prevention and clinical management of snakebite in Africa' (2010), indicate a puff adder (Bitis arietans) bite and similar treatment. Snakebite treatment guidelines need an update on psychological co-morbidity.</p> <p><strong>Key words</strong>: Snakebite treatment, who guidelines, lubwe mission hospital, Zambia, puff adder, psychological co-morbidity</p> Jules Tolboom Copyright (c) 2021-04-22 2021-04-22 48 1 67 69