bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of Cefotaxime in the prevention of surgical site infections in children undergoing elective inguinal surgery at the University Teaching Hospital, Lusaka, Zambia
Authors: Patel Azad , Bvulani Bruce 
Published: November 2022

Introduction and objectives: Inguinal operations are the most performed surgeries in children. There is a divergent view on use of pre-operative antibioticprophylaxis to prevent Surgical site infections (SSI) after these surgeries. The aim of this study was to detect if the use of cefotaxime had a significantimpact 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.
Table of Contents, Medical Journal of Zambia Volume 48 Number 2
Authors: Zambia Medical Journal 
Published: November 2022

The Medical Journal of Zambia is a peer-reviewed quarterly journal intended for the publication of papers from all specialities of medicine (Internal Medicine, Surgery, Paediatrics and Obstetrics & 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).
The Interactions of Public Health Organisational Leadership with its Environment: A Case Study of the Sally Mugabe Central Hospital in Harare, Zimbabwe
Authors: Kasu Tonderai Irvine , Mungure, Solomon , Menelik Girma , Mharakurwa Sungano 
Published: November 2022

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 someapplicability 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.
Head and Neck Lymphatic Malformation Management Algorithm: An Experience from a Tertiary Centre in Tanzania
Authors: Sohal Karpal Singh , Mungia Abbas M , Moshy Jeremiah Robert , Owibingire Sira Stanslaus , Mtenga Arnold A , Berege Gemma Z 
Published: November 2022

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 ofthe 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 2 patients was 12.00 cm . 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.
Image Interpretation and Reporting by Radiographers in Africa: Findings from the Literature Review and their Application to Zambia
Authors: Bwanga Osward , Sichone James Maimbo , Sichone Phanny Nankonde , Kazuma Yakomba Biye 
Published: November 2022

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 reportson 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 thefindings 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
Authors: Kazuma Seke Manase Ephraim , Musowoya Joseph , Kaela Boniface , Simunyama Luyando , Mundia Kamwi , Kaoma Donald , Lumbala Mukendi , Khumbolakhe Fisonga 
Published: November 2022

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 PPand therefore underwent emergency laparotomy. The cyst wall was immature and therefore a cystenterostomy was not possible. PP excision was chosen because the PPwas 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.
Diagnosis of Hunter Syndrome (Mucopolysaccharidosis Type II) in a Resource­ Limited Setting: A Case Report from Zambia
Authors: Nchimba Lweendo , Mpabalwani Evans Mwila , Inambao Muleya , Kawatu Nfwama 
Published: November 2022

Abstract
Hunter syndrome is one of the Mucopolysaccharidosis (MPS), type II. It is a rare genetic disorder due to a deficiency in the enzyme Iduronate 2-sulphatase. This deficiency leads to the accumulation of glycosaminoglycans (GAGs) dermatan sulphate and heparan sulphate. The GAGs accumulate both intracellularly and extracellularly, leading to abnormalities in different organ systems in the body. The definitive diagnosis of Hunter syndrome requires biochemical methods which can be a challenge in resource-limited settings, Zambia included. Presented here is a case of Hunter Syndrome in a 12-year-old male child and highlight clinical acumen as the main ingredient in making the diagnosis and distinguishing different types.
The Pattern of Fracture Occurrence among Children Aged 1-17 Years Presenting At Solwezi General Hospital in Solwezi District, Zambia
Authors: Mwiinga Fair Banji 
Published: November 2022

Introduction: Fractures in children represent a major global health problem and account for 10- 25% of all childhood injuries. Childhood fractures are caused by falls, domestic violence and road traffic accidents. Locally, there is a paucity of data on the pattern of fracture occurrence among children in Solwezi District.
Objectives: The objectives of this study were to determine the pattern of childhood fractures in terms of the causes, severity, circumstances and geographical location in which these injuries occur, and recommend strategies for preventing these mJunes.
Materials & methods: Data collection was done using a researcher assisted questionnaire in a cross­ sectional survey and analysed using the SPSS software version 20.0 for Windows. The Chi-square test was used to test association of variables at the 0.05 level of significance.
Results: The mean age of children with fractures under review was found to be 6.88 years (SE of mean=0.453). Fractures in children were found to occur more frequently in the pre-school age group (48.3%, n=43). A male predominance in childhood fracture occurrence was noted as these fracture injuries occurred in 60.7% (n=54) of the males and 39.3% (n=35) of the females. Fractures of the upper limbs (74.2%) were more frequent than those of the lower limbs (25.8%) with the Radius (51.7%) and Ulna (22.5%) being the most frequently fractured bones. No respondent had an open fracture. Falling was the most frequent cause of injury in 73% of the respondents followed by sports injuries (13.5%). Fifty-six percent (n=50) of the fractures in children were sustained at home followed by school (16.9%) and road (19.1%). Statistically significant associations were found between respondent's age group and mechanism of injury (p-value=0.004) as well as between respondent's area of residence and geographical location ofinjury (p-value=0.005).
Conclusion: Falls are the most frequent mechanism of injury in childhood fractures seen at Solwezi General Hospital with the Radius and Ulna being the most frequently affected bones. The majority of these fractures occur at home as a result of slight trauma events. Clinically, this implies that the home advice given to patients and guardians should be tailored towards the prevention of these injuries in the settings in which they occur. General safety guidelines and policies for prevention of childhood fractures at home and in schools should be developed.
The Obstetric outcomes associated with advanced maternal age at the University Teaching Hospitals Women and Newborn Hospital in Lusaka, Zambia
Authors: Simute Felix , Kasonka Lackson , Vwalika Bellington 
Published: November 2022

Introduction: Pregnant women aged 35 years and above have traditionally been termed as of advanced maternal age. These women are considered to have a higher incidence of obstetric complications than younger ones
Objectives: To investigate socio-demographic characteristics and obstetric outcomes in women of advanced age who delivered at the Women and Newborn Hospital, in Lusaka, Zambia.
Methods: This was a cross-sectional study in which a total of 226 postnatal women, both of advanced (35 years and above) and optimal age (20 - 34 years), that met the eligibility criteria were recruited. Systematic random sampling was used to recruit study participants and data was collected using a structured questionnaire, review of patient's hospital records, and the labour ward delivery registers. Statistical analysis was performed using a statistical package for social sciences (SPSS) version 26 software.
Results: The prevalence of advanced maternal age was 14.1%. The mean ages were 38years (range 35 - 46 years) and 28 years in advanced and optimal maternal age groups respectively. Socio­ demographic characteristics that were found to be significantly associated with advanced maternal age included; education (P=0.036), occupation (P= 0.015), the cultural belief of large families (P=0.003), and contraception use (P= 0.001). There were more married women among advanced age women 105 (92.9%) than among optimal age women 99 (87.2%), however, there was no significant difference between the two groups (P=0.262). Divorce (P=0.689), income (P=0.701), and history of subfertility P=0.291) were also not found to be different between the two groups. With regards to maternal outcomes, advanced maternal age was significantly associated with severe pre­ eclampsia (AOR 2.131; 95% CI 1.190 - 3.816; P=0.011), postpartum haemorrhage (AOR 1.400; 95% CI 0.187 - 0.855; P=0.018), caesarean deliveries (AOR 1.395; 95% CI 1.115 - 4.719; P=0.028) and antepartum haemorrhage (AOR 2.425; 95% CI 1.029 - 5.714; P=0.043). On foetal outcomes, advanced maternal age was significantly associated with NICU admissions (AOR 3.075; 95% CI 1.298 - 7.287; P=0.011). However, there was no association with APGAR score at 5 minutes (P=0.174), birth weight (P=l.000), gestation age at birth (P=0.676), and PROM (P=0.557)
Conclusion: Generally, women of advanced maternal age were associated with more adverse obstetric outcomes than women of optimal childbearing age. Hence, there is a need to sensitise these women and their spouses on the risk of advanced maternal age on obstetric outcomes and the need for not postponing conception until the late 3rd decade of life.
An Audit of Computed Tomography (CT) Services in Zambia
Authors: Kafwimbi Stefan , Bwanga Osward , Sichone James Maimbo 
Published: November 2022

Background: In Zambia, Computed Tomography (CT) has been available since 1994 as part of the healthcare delivery pathway. Radiographers undertake CT examinations of the body to diagnose diseases, injuries and to plan for radiotherapy.
Objective: The aim of this study was to audit CT services in Zambia.
Methodology: The study used a convergent parallel design in which quantitative and qualitative data were collected concurrently using an online questionnaire. Quantitative data were analysed using descriptive statistics, whilst qualitative data were analysed by themes.
Results: Out of the 23 facilities, a total of 22 responded. Results indicated that Western and Central provinces did not have CT scanners. Most CT facilities are in the Lusaka province. 59% (N=13) and 41% (N=9) were from the public and private sectors, respectively. In public hospitals, 46% (N=6) of CT scanners were functional with service contracts and 89% (N=8) were functional in the private hospitals with service contracts. 61.5 % (N=8) of public hospitals had maintenance schedules while 89% (N=8) of private hospitals had maintenance schedules. A total of 7 facilities reported having radiographers with a qualification in CT. 12 out of 22 facilities indicated having a radiologist with average patient waiting times for CT reports being 76 hours and 24 hours in public and private facilities, respectively.
Conclusion: This audit revealed an unequal distribution of CT scanners characterised by poor maintenance and lack of service contracts, especially in public hospitals. The audit also revealed longer waiting times for CT reports in public than in private hospitals.
Cardiopulmonary Resuscitation among Nursing Staff At A Tertiary Health Facility: A Cross-Sectional Study
Authors: Aina Monisola , Bolarinwa Oladimeji A , Adeniran Peace I , Oyedepo Dapo S , Adeniran Abiodun S 
Published: November 2022

Background: Cardiopulmonary Resuscitation (CPR) is an emergency life-saving care to restore blood circulation following cardiac arrest. Nurses are often the closest when cardiac arrest occurs, thus their competence and initiation of CPR could be life-saving.
Aim: To evaluate the knowledge, attitude and willingness to initiate CPR among nurse practitioners.
Methods: A cross-sectional study was conducted; participants were nursing staff at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Nursing students and other healthcare workers were excluded from the study. Multistage sampling method was used and all participants completed a self-administered questionnaire after informed consent. Data analysis was with SPSS version 21.0 and p<0.05 was significant.
Results: Among the 220 participants, 35(15.9%) were ≤5years post-qualification, 100(45.5%) had sub-specialty training, awareness about CPR was 100%, 66(30%) showed good knowledge on the practice of CPR, 154(70%) had formal training on CPR, 112 (50.9%) of the training were during schooling while 182(82.7%) showed good attitude towards initiating CPR when indicated. Hindrances to initiation of CPR included lack of training (56.2%), heavy workload (47.3%), inadequate knowledge (42.8%), lack of equipment (41.8%) and difficulty establishing diagnosis of cardiac arrest (13.9%). Competence grading for CPR was 48.4% for participants with surgical, 40.0% for medical subspecialty training and 44.2% for non-subspecialists. There was statistical significant relationship between competence in CPR and knowledge about it (p=0.026).
Conclusion: Knowledge and practice of CPR among nurses was low; health institutions and the mandatory nursing professional development programs should prioritize post-qualification training of nurses in the life-saving skills of CPR.
A Catamenial Pneumothorax: Role Of Serial Chest Radiographs In The Diagnosis Of ARare Entity .
Authors: Chinene Bornface 
Published: November 2022

Catamenial Pneumothorax is generally considered to be a rare entity. The lack of a clear cause means that diagnosis and treatment is challenging. The objective of this case report is to increase awareness and highlight the role of serial chest radiographs in improving the diagnosis of the pathology. A 33-year-old mother of two presented at the radiology department with a history of recurrent right-sided chest pain that corresponded with her menstrual period. Previous chest radiographs performed in the preceding six months all showed the presence of a right-sided pneumothorax, with associated pleural effusion. In considering the patient’s age, spontaneous pneumothorax occurring in conjunction with the menstrual cycle, and in the absence of other respiratory diseases, a diagnosis of catamenial pneumothorax was made. The patient was commenced on oral contraceptive pills (oestrogen-progestogen) and she recovered.