The University Teaching Hospital (UTH) formerly Lusaka hospital is the biggest public tertiary hospital in Lusaka, Zambia. It is the largest hospital with 1,655 beds. It is a teaching hospital and, as such, is used to train local medical students, nurses and other health professionals. UTH is the main medical training institution in Zambia for doctors, nurses, clinical officers and other health professionals. It provides primary, secondary and tertiary care..
Klebsiella pneumoniae is a leading cause of neonatal sepsis in low- and middle-income countries, with antimicrobial resistance (AMR) significantly contributing to mortality. We used whole genome sequencing to explore the impact of an infection prevention and control (IPC) intervention on K. pneumoniae strains and transmission dynamics responsible for sepsis in a Zambian neonatal unit. Blood culture isolates were collected during the Sepsis Prevention in Neonates in Zambia (SPINZ) study, including a 7-month baseline period and 12 months following implementation of a low-cost IPC bundle. K. pneumoniae genomes associated with 411 neonatal infections were characterised, comprising 24 unique sequence types (STs) and dominated by ST307 (69.3%, n = 285). Nearly all isolates (99.0%) carried extended spectrum beta-lactamases, but few carried carbapenemases (2.7%). Most infections (95.6%) were associated with probable transmission clusters, ranging in size from 2-202 patients and spanning durations of 2-232 days. Most K. pneumoniae (n = 228, 70%) were isolated during the 7-month baseline period and formed six clusters, including one cluster of >200 neonates infected with ST307. Transmission of all strains was periodically suppressed by an IPC bundle; however not all strains were eliminated, and some were able to re-emerge later to re-establish infection and transmission, alongside newly introduced strains that formed additional transmission clusters. Some clusters were associated with rapid onset of disease (within 2 days of admission) and others with delayed onset, suggesting different sources of contamination (e.g., reagent vs environmental). These findings reinforce the need for sustained IPC efforts, and better understanding of environmental reservoirs of opportunistic pathogens in neonatal units to inform such efforts.
Oral squamous cell carcinoma (OSCC) is the most common oral cancer worldwide, with a high mortality that is associated with a delay in diagnosis, especially in areas with poorly developed health infrastructure. The purpose of this study is to determine if salivary glutathione and selenium levels are significantly different between oral cancer patients and healthy subjects. Levels of salivary glutathione, a biomarker of oxidative stress seen in oral cancer and selenium, which augments its function, were compared in healthy low-risk (control), healthy high-risk and oral cancer patients. A reduced level of glutathione was found in oral cancer cases (5.047 ± 0.5115 µM) compared to healthy high-risk patients (5.273 ± 0.3240 µM) and healthy low-risk control subjects (5.618 ± 0.5213 µM), while salivary selenium levels were elevated in oral cancer and healthy high-risk groups compared to healthy low-risk controls. Salivary glutathione level could be a predictor of risk of oral cancer and as a marker for assessment of the effectiveness of management of oral cancer cases, towards improved patient care.
BACKGROUND:Limited data is available about the availability of multiple sclerosis (MS) therapies and services in Africa. OBJECTIVE:We aimed to investigate the availability, affordability, frequency of usage, and insurance coverage of MS therapies and services across Africa. METHODS:A comprehensive web-based survey was constructed and distributed to neurologists from different African countries. The survey addresses availability, affordability, frequency of use, and insurance coverage of different therapies and services of MS. RESULTS:Respondents represented 27 African countries. Intravenous methylprednisolone was always available in most countries (88.9%), while interferons were completely or partially available in 13 countries (48.1%). The most available disease-modifying therapies (DMTs) were rituximab (22 countries, 81%), followed by interferon beta 1a intramuscular type (12, 44.4%). Availability of other DMTs was variable, while specific MS services were limited. Affordability is limited in most countries, and the use of DMTs was related to insurance coverage. Most associated therapies and investigations were more available and affordable, but less insured. Neurologists were the main healthcare providers, but traditional healers had a role in 14.8% of countries. CONCLUSION:Significant challenges characterize MS care in Africa. MS therapies, particularly DMTs and services, are inaccessible and unaffordable in most African countries.
PURPOSE:Zambia is among the countries with the highest cervical cancer incidence and mortality rates globally. Stigma can hinder treatment adherence and overall quality of life for patients with cervical cancer. Research on this topic, however, is lacking in Zambia. This study aimed to assess the levels of stigma among patients with cervical cancer in Zambia and examine the association between social support and quality of life. METHODS:We enrolled patients newly diagnosed with cervical cancer at the Cancer Diseases Hospital in Lusaka, Zambia, from July to October 2024. In-person or telephone interviewers collected information on demographic, clinical, and socioeconomic status before treatment. Stigma was assessed using a modified Perceived Stigma Scale, quality of life using the PROMIS-57, and social support with the Multidimensional Scale of Perceived Social Support. Associations between stigma, social support, and quality of life were analyzed using multivariable logistic regression, adjusting for age, education, income, and cancer stage, with significance set at P < .05. RESULTS:A total of 213 participants were included in the study with a response rate of 96%. Of the total participants, 30.5% were classified as having high stigma. High levels of support from family (odds ratio [OR], 0.44 [95% CI, 0.22 to 0.87]) and friends (OR, 0.43 [95% CI, 0.21 to 0.91]) reduced the odds of stigma. Severe anxiety, depression, fatigue, sleep disturbances, pain, poor physical function, and low social well-being were all strongly associated with higher stigma (all P ≤ .004). CONCLUSION:Perceived cervical cancer-related stigma in Zambia is associated with limited social support and poorer quality of life. Programs to strengthen social network support, as well as targeted mental health treatment, are needed to improve the well-being of patients with cervical cancer in Zambia.
