48 research outputs found
sj-docx-2-whe-10.1177_17455057221111326 – Supplemental material for Psychosocial issues and coping mechanisms of pregnant and postnatal women diagnosed with COVID-19: A qualitative study
No full textSupplemental material, sj-docx-2-whe-10.1177_17455057221111326 for Psychosocial issues and coping mechanisms of pregnant and postnatal women diagnosed with COVID-19: A qualitative study by Jane Chanda Kabwe, Mwansa Ketty Lubeya, Christabel Chigwe Phiri, Mubanga Mulenga, Ntungo Siulapwa, Patrick Kaonga, Joan T. Price, Selia Ng’anjo Phiri and Choolwe Jacobs in Women’s Health</p
sj-docx-1-whe-10.1177_17455057221111326 – Supplemental material for Psychosocial issues and coping mechanisms of pregnant and postnatal women diagnosed with COVID-19: A qualitative study
No full textSupplemental material, sj-docx-1-whe-10.1177_17455057221111326 for Psychosocial issues and coping mechanisms of pregnant and postnatal women diagnosed with COVID-19: A qualitative study by Jane Chanda Kabwe, Mwansa Ketty Lubeya, Christabel Chigwe Phiri, Mubanga Mulenga, Ntungo Siulapwa, Patrick Kaonga, Joan T. Price, Selia Ng’anjo Phiri and Choolwe Jacobs in Women’s Health</p
Seroprevalence of Co-Infection of HSV-2 and HIV in Clients attending VCT at The University Teaching Hospital
No full textThe main objectives of this study are to explore the seroprevalence of co-infection of Human immunodeficiency virus and Herpes Simplex Virus-2 in clients attending voluntary counselling and testing (VCT), seroprevalence of HSV-2 among HIV negative and HIV positive and to determine associations between demographic and sexual behaviour factors on one hand and co-infection on the other.This was a descriptive study that was conducted at University Teaching Hospital in clinic 3. This clinic is a Sexually Transmitted Infections clinic which also has VCT services. The study was conducted on clients who were attending VCT for a period of three months.Clients attending VCT were asked to complete a VCT standard and a HSV-2 questionnaires. In the HSV-2 questionnaire, clients were asked questions about demographic and sexual behavioural factors. These clients were between 18 and 49 years old. For each client who gave consent, 4 millilitres of venous blood was collected once for HIV and HSV-2 tests. For testing HIV Abbott determine was used (screening test) with a sensitivity of 100% and specificity of 99.7%. The Uni-Gold test was used for confirmatory testing with sensitivity of 100% and specificity of 100%.
For HSV-2 testing, indirect ELISA IgG which has the sensitivity of 99.4% and specificity of 98% was used.Before getting results, clients were also given post test counselling. Those who were found seropositive for both or either of the two viruses were referred to clinicians for management.The co-infection rate among clients attending VCT was 17.9% (41/229). The seroprevaence of HSV-2 among HIV positive clients was 59.4% (41/69) compared to seroprevalence of HSV-2 among those who were HIV negative of 13.7% (22/160). The sex distribution was significantly different between males and females (p = 0.029). Females were more likely to be co-infected than males. No age difference was observed between the two age groups those aged 18 to 34 and those between 35 and 49 years old. There was association between condom use and the co-infection (X^ 11.00; p value 0.004), while multiple sex partners yielded no significant association (p= 0.234). Those clients who reported with history of sexually transmitted infections were more likely to be co-infected than those who reported no history of sexually transmitted infections. The level of education showed no significant association with co-infection.
Condom use, history of sexually transmitted infections and sex were all statistically significantly associated with co-infection. Those clients who reported non condom use, history of STIs and females were more likely to be co-infected. There was no significant different between educational level and co-infection as well as multiple sex partners and co-infection in this study.According to our results, we need to screen for HSV-2 in clients attending VCT because HSV-2 is also common in these clients. We also need counselling for both HIV and HSV-2 due to the fact that there is likehood of co-infection. There is need for more health promotion about condom use to prevent infection as reported elsewhere to reduce both HIV and HSV-2 infections. More research needs to be done in order to get more information on the screening for HSV-2 in VCT centres
Direct biomarkers of microbial translocation as predictors of immune activation in adult Zambians with environmental enteropathy and hepatosplenic schistosomiasis.
No full textThesis of of Doctor of Philosophy in ImmunologyBackground: Microbial translocation is a poorly understood consequence of several disorders such as environmental enteropathy (EE) and hepatosplenic schistosomiasis (HSS) disease. Direct biomarkers of microbial translocation such lipopolysaccharide, 16S rRNA gene and Toll-like receptor ligands may predict immune activation. This study evaluated whether direct biomarkers of microbial translocation correlate and predict immune activation in adult Zambians with EE and HSS disease. The public health importance of biomarkers is that they can be used to predict individuals with EE or HSS who are likely to develop chronic immune activation or are at risk. The biomarkers may be used for early diagnosis and stratify for any treatment or intervention.
Methods: An unmatched case-control study was conducted in participants with EE (n=67) recruited from Misisi compound, Lusaka, Zambia, with two comparison groups, HSS participants (n=86) from The University Teaching Hospital and healthy controls (n=41). Plasma lipopolysaccharide (LPS) was measured by Limulus Amoebocyte Lysate Assay, plasma 16S rRNA gene copy number was quantified by quantitative real-time PCR, Toll-like receptor ligands (TLRLs) activity by QUANTI-Blue detection medium, plasma biomarkers of host response (C-reactive protein, soluble CD14, soluble CD163 and lipopolysaccharide-binding protein) to microbial translocation were measured by ELISA and cytokines (TNF-α, IL-6, IL-10, IL-4, IL-2, IFN-γ and IL-17) from cell culture supernatant by Cytometric Bead Array.
Results: Plasma lipopolysaccharide levels were elevated in EE group with median 378.9 (IQR, 82.7 - 879.5) EU/ml compared to participants with HSS with median 213.1 (IQR, 77.2 - 358.3) EU/ml; p=0.03 or healthy controls with median 202.3 (IQR, 43.2 - 251.1) EU/ml; p=0.01. The 16S rRNA copy number were significantly elevated in the EE group with median 2651 (IQR, 529 – 8779) copies/μl compared to the levels in participants with HSS with median 387 (IQR, 165 – 1990) copies/μl; p<0.001) or healthy controls with median 193 (IQR, 132 – 455) copies/μl; p<0.001. TLRLs activity was significantly higher in the EE group with median 0.49 (IQR, 0.0 - 0.8) OD units than in participants with HSS with median 0.13 (IQR, 0.0 - 0.8) OD units; p=0.01 or the healthy controls with median 0.02 (IQR, 0.0 - 0.12) OD units; p=0.004. Participants with HSS had higher TLRLs activity compared to healthy controls p=0.02. In multivariate multiple regression models LPS, 16S rRNA copy number, and TLRL activity were independent predictors of cytokines while controlling for baseline characteristics. In the EE group, a good model fit was obtained (R2 = 0.526, F = 47.53, p < 0.001) which predicted TNF-α, IL-6, and IL-10. In the HSS group, a less impressive but still significant fit was obtained (R2 = 0.382, F = 22.43, p = 0.002 which predicted 16S rRNA and TLRLs. In healthy controls, no satisfactory model was obtained (R2 = 0.040, F =1.03, p = 0.38).
Conclusions: Direct biomarkers of microbial translocation were higher in EE and HSS participants compared to healthy controls. The biomarkers seems to correlate and predict immune activation in individuals with EE and HSS infection. This data support the model that proposes that biomarkers of microbial origin in the gastrointestinal tract move across a
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compromised intestinal barrier leading to heightened immune activation in conditions with intestinal barrier dysfunction. The study recommends measurement of microbial translocation using these biomarkers. They are cheaper, practical and non-invasive
Mortality Classification of Hospitalized COVID-19 Patients in Zambia Using Machine Learning
No full textSupplemental Materials: https://osf.io/mbndg/The Corona Virus Disease 2019 (COVID-19) has wreaked havoc globally, resulting in millions of cases and deaths. The objective of this study was to predict mortality in hospitalized COVID-19 patients in Zambia using machine learning (ML) methods based on factors that have been shown to be predictive of mortality and thereby improve pandemic preparedness. This research employed seven powerful ML models that included: decision tree (DT), random forest (RF), support vector machines (SVM), logistic regression (LR), naïve bayes (NB), gradient boosting (GB), and XGBoost (XGB). These classifiers were trained on 1,433 hospitalized COVID-19 patients from various health facilities in Zambia. The performances achieved by these models were checked using accuracy, recall, F1-Score, area under the receiver operating characteristic curve (ROC_AUC), area under the precision-recall curve (PRC_AUC), and other metrics. The best performing model was the XGB which had accuracy of 92.3%, recall of 94.2%, F1-Score of 92.4%, and ROC_AUC of 97.5%. The pairwise Mann-Whitney U-test analysis showed that the second-best model (GB) and the third-best model (RF) did not perform significantly worse than the best model (XGB) and had the following: GB had accuracy of 91.7%, recall of 94.2%, F1-Score of 91.9%, and ROC_AUC of 97.1%. RF had accuracy of 90.8%, recall of 93.6%, F1-Score of 91.0%, and ROC_AUC of 96.8%. Other models showed similar results for the same metrics checked. The study successfully derived and validated the selected ML models and predicted mortality effectively with reasonably high performance in the stated metrics. The feature importance analysis found that knowledge of underlying health conditions about patients’ hospital length of stay (LOS), white blood cell count, age, and other factors can help healthcare providers offer lifesaving services on time, improve pandemic preparedness and decongest health facilities in Zambia and other countries with similar settings
Comparison of Viral Load Suppression among HIV-1 Infected Children Aged 5 to 12 Years on Once Daily Versus Twice Daily Abacavir-Containing Regimens at University Teaching Hospitals - Children’s Hospital, Lusaka, Zambia
No full textAbacavir is one of the first-line drugs used to treat HIV infection in paediatric patients in Zambia, whose use in children has not been widely published. This study compared the virologic response of abacavir given as part of a once-daily regimen with the response when given as part of a twice-daily regimen. A total of eighty-two children aged two to twelve years currently receiving antiretroviral therapy at the Paediatric Centre of Excellence, University Teaching Hospitals, Lusaka, Zambia, were observed in the study. This was a prospective cohort study. All the children were initially on twice daily abacavir containing regimen with lamivudine twice daily and efavirenz once daily, with 40 maintained on this regimen by the attending clinician and 42 switched to once-daily abacavir, lamivudine and efavirenz by the attending clinician. Profiles were obtained for each child to compare viral load at baseline and week 24. Data was analysed using Stata Version 16.The proportion of children with undetectable viral load in the once-daily group at twenty-four weeks was 64.3 per cent compared to 72.5 per centin the twice-daily group. Twice-daily dosing reduced the odds of achieving an undetectable viral load by about 59 per cent, while being male reduced the odds of achieving an undetectable HIV viral load by 19.6 per cent. Baseline haemoglobin, creatinine, or alanine transferase levels were not predictors of viral load suppression.The study suggests that once-daily dosing of an abacavir-containing regimen achieved a lower viral suppression rate when compared to twice-daily dosing. It is recommended that once-daily dosing of abacavir containing regimen should be considered as a dosing option for Zambian children living with HIV
Prevalence and Determinants of Virological Non-Suppression Among HIV Infected Adolescents on Antiretroviral Treatment At Kanyama General Hospital, Lusaka, Zambia
No full textBackground
Zambia continues to face challenges in addressing the HIV epidemic among adolescents. Despite implementing various interventions to improve viral suppression among adolescents, the proportion of adolescents achieving viral load (VL) suppression remains low compared to the adults, and below the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95% target. Therefore, the study estimated the proportion and determined the factors associated with non-suppression among HIV infected adolescents on antiretroviral treatment at Kanyama General Hospital, Lusaka, Zambia
Methods
A cross-sectional study was conducted using routinely collected data from SmartCare on adolescents (10 – 19 years) receiving ART for the period 1st January 2020 to 30th September 2022. Demographic and clinic characteristics data was extracted. The study defined virological non-suppression as having VL count ≥1000 RNA copies/mL. The study used multivariable logistic regression to identify factors associated with virological non-suppression. Data analysis was conducted in Stata 14.
Results
Of the 415 study participants, majority were 15-19 years (62.4%, 259/415) were female (56.6%, 235/415). The proportion of non-suppression was 5.8% (24/415, 95% CI=0.04-0.08). Age and sex showed no significant association with virological non-suppression, indicated by p-values of 0.089 and 0.310, respectively. Both treatment duration on ART and current treatment line were identified as determinants of virological non-suppression, with treatment duration on ART showing slightly decreased odds of (AOR=0.99, 95% CI=0.98-1.00) and being on the 2nd treatment line/regimen was associated with increased odds (AOR=8.09, 95% CI=2.71-24.17) of virological non-suppression.
Conclusion
The study found a prevalence of 5.8% virological non-suppression among adolescents. Treatment duration on ART and 2nd treatment line/regimen were found as determinants of virological non-suppression. Need to continuously monitor adolescent’s treatment duration on ART to avoid them moving 2nd treatment line/regimen
Determining household out of pocket payments, incidence of catastrophic expenditures and impoverishment among patients with malaria in Zambia’s path towards Universal Health Coverage
No full textInformation and Communication Technology for Child Protection Case Management in Emergencies: An Overview of the Existing Evidence Base
No full textAbstractOrganizations working to protect the health and wellbeing of children in emergencies are moving away from traditional paper-based systems towards more sophisticated and innovative digitally-based systems. Formative research was conducted to identify the state of the current evidence base on the use of information and communication technology (ICT) for child protection case management in emergencies (CPCME). Most of the evidence is from the grey literature, and the sector is still nascent in linking ICT implementations to improvements in efficiencies of case management processes and outcomes in children. However, our preliminary findings, gleaned mostly from key informant interviews and reports, strongly suggest that using certain ICT applications can have a beneficial influence on reducing children's vulnerabilities and other key outcomes in emergency settings. The preliminary findings form the basis for currently ongoing subsequent research that will ultimately inform how ICT for CPCME can best contribute to improved outcomes in children in such settings. While there are challenges in the design, implementation, evaluation, and enabling environment to support ICT for CPCME that limit their potential impact, each challenge presents an opportunity for child protection programs to consider as the use of ICT for CPCME increases and matures over the next few years
Predicting Mortality in Hospitalized COVID-19 Patients in Zambia: An Application of Machine Learning
No full textThe coronavirus disease 2019 (COVID-19) has wreaked havoc globally, resulting in millions of cases and deaths. The objective of this study was to predict mortality in hospitalized COVID-19 patients in Zambia using machine learning (ML) methods based on factors that have been shown to be predictive of mortality and thereby improve pandemic preparedness. This research employed seven powerful ML models that included decision tree (DT), random forest (RF), support vector machines (SVM), logistic regression (LR), Naïve Bayes (NB), gradient boosting (GB), and XGBoost (XGB). These classifiers were trained on 1,433 hospitalized COVID-19 patients from various health facilities in Zambia. The performances achieved by these models were checked using accuracy, recall, F1-Score, area under the receiver operating characteristic curve (ROC_AUC), area under the precision-recall curve (PRC_AUC), and other metrics. The best-performing model was the XGB which had an accuracy of 92.3%, recall of 94.2%, F1-Score of 92.4%, and ROC_AUC of 97.5%. The pairwise Mann–Whitney U-test analysis showed that the second-best model (GB) and the third-best model (RF) did not perform significantly worse than the best model (XGB) and had the following: GB had an accuracy of 91.7%, recall of 94.2%, F1-Score of 91.9%, and ROC_AUC of 97.1%. RF had an accuracy of 90.8%, recall of 93.6%, F1-Score of 91.0%, and ROC_AUC of 96.8%. Other models showed similar results for the same metrics checked. The study successfully derived and validated the selected ML models and predicted mortality effectively with reasonably high performance in the stated metrics. The feature importance analysis found that knowledge of underlying health conditions about patients’ hospital length of stay (LOS), white blood cell count, age, and other factors can help healthcare providers offer lifesaving services on time, improve pandemic preparedness, and decongest health facilities in Zambia and other countries with similar settings
