key: abbreviationInvalid data type in setData: Med Jnl Zamkey: aboutInvalid data type in setData: <h3>Open Access Policy</h3>This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.<h3>Publication Scheduling</h3>3 issues per year<h3>General</h3><div style="font-weight:bold">Subscriptions: Hard copies</div><div id="about">The journal is published quarterly. The following rates are for four regular issues of the journal per year plus supplements. They include postage by air mail. Institutions and Individuals: Within Zambia: K210,000 Within the SADC Region: US450.00 Rest of Africa: US460.00 United Kingdom/Europe: US$65.00 United States: US$70.00</div>key: acronymInvalid data type in setData: MJZkey: authorGuidelinesInvalid data type in setData: <p>Correspondence <br>All manuscripts and queries regarding manuscripts should be sent to: The Editor Medical Journal of Zambia Editorial Office Dept. of Medicine Room 39 P/Bag RW 1X University Teaching Hospital, Lusaka Zambia. <br>Except for letters to the editor where only one copy is required, all other articles should be submitted in triplicate (i.e. three copies) and an electronic version preferably submitted as an attachment to an email. Additional illustrations and photographs are to be attached as JPEG documents. Authors from the University Teaching Hospital in Lusaka may find it quicker to submit their articles through the e-mail: MedJZambia@yahoo.com.</p>
<p>Manuscripts Papers should be clear, precise and logical. The Journal welcomes submissions in any of the following categories: original articles, review articles, short reports, case reports, letters to the editor, and conference reports, as well as articles of medico-political nature (e.g. points of view).<br>Papers describing a particular event (e.g. an outbreak of infectious disease) should be submitted as soon as possible after the event. <br>Original articles and review articles should not exceed 3000 words, including the references. <br>Short reports and articles submitted as points of view should not exceed 1000 words. <br>Letters to the editors should be concise, not exceed 500 words and should not be accompanied by more than one table or figure.</p>
<p>The paper must be typewritten, on one side of the paper only, double-spaced throughout with margins on both sides of at least 2.5cm (one inch). Words to appear in italics should be underlined. Headings should not be underlined.</p>
<p><strong>Copyright </strong><br>It is condition of publication in the journal that the author 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 Medical Journal of Zambia.</p>
<p><strong>Condition of Acceptance </strong><br>Articles are accepted for publication on condition that they are contributed solely to Medical Journal of Zambia. The editor cannot enter into correspondence about papers considered unsuitable for publication and the decision is final. Neither the editor nor the publishers accept responsibility for the views.</p>
<p><strong>Authorship </strong><br>The Journal advises potential authors to ensure that only individuals who have made a substantial contribution to the scientific (or otherwise) merit of the work are included on the authorship. Underserved or passive authorship is discouraged. The Journal will normally not accept more than six (6) authors per single paper. Papers not fulfilling this requirement will be returned for justification of authorship.</p>
<p>Papers should be sent out as follows: <br>1. Title page bearing title, all authors, initials, surnames, main degrees (up to two only) and the name and location of the institution where the work was done. <br>2. Abstract: This should briefly outline the content of the paper under the following headlines: objectives, design, main outcomes, measures, results and conclusions. <br>3. Introduction <br>4. Methods <br>5. Results <br>6. Discussions <br>7. Acknowledgement <br>8. References</p>
<p>Review articles and other contributions that may not easily comply with the above layout should have appropriate subheadings instead. Tables and figures should be kept to a minimum. Tables must be comprehensible without reference to the text. Reference should not be cited in the tables. Authors should indicate at approximately what point in the text the table should appear. Figures, graphs, drawings etc., should be on separate sheets, numbered and executed in black ink and given suitable legends. Illustrations and tables should be kept separate from the text.</p>
<p><strong>References</strong> <br>References should be in the order made in the text and numbered accordingly using figures (numbers). These numbers should be inserted at the end of the paper and should consist of the surnames and initials of all authors when six or less, when seven or more, list the first three and add the words et al, title of article, full name of Journal, year, volume, first and last page numbers, as follows: 1. Ng’andu, N.H. and Watts, T.E. Child growth and breast feeding in Urban Zambia. Journal of Epidemiology and Community Health 1992; 44:281-285. 2. For books, names and initials of all author, the full title, place of publication, publishers, year of publication and page number should be given. Authors should personally verify the accuracy of every reference before submitting the paper for publication and should ensure that the listed references correspond exactly to those in the text.</p>
<p>A checklist for authors and contributors <br>• Must ensure you have submitted three copies of the manuscript. <br>• Be sure you have used the referencing style of the journal. <br>• Make sure every legends for illustrations are clearly written. <br>• Illustrations must be of good quality, unmounted glossy prints, usually 17x173mm, or attached as JPEG documents electronically. <br>• Has a colleague assessed your paper before submitting it? <br>• Take time to go through the instructions for authors and assess where your manuscript stands.</p>key: contactAffiliationInvalid data type in setData: University Teaching Hospital, Lusakakey: copyrightNoticeInvalid data type in setData: 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.key: descriptionInvalid data type in setData: <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>key: editorialTeamInvalid data type in setData: <div style="font-weight:bold">Editorial Office Details</div><div id="editorialTeam">Dept of Medicine Room 39 University Teaching Hospital Lusaka Postal Address P/Bag RW 1X Lusaka Zambia</div>key: licenseTermsInvalid data type in setData: 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.key: lockssLicenseInvalid data type in setData: This journal utilizes the LOCKSS system to create a distributed archiving system among participating libraries and permits those libraries to create permanent archives of the journal for purposes of preservation and restoration. <a href="http://lockss.org/">More...</a>key: membershipFeeDescriptionInvalid data type in setData: The payment of this fee will enroll you as a member in this association for one year and provide you with free access to this journal.key: membershipFeeNameInvalid data type in setData: Association Membershipkey: nameInvalid data type in setData: Medical Journal of Zambiakey: openAccessPolicyInvalid data type in setData: This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.key: privacyStatementInvalid data type in setData: The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.key: publicationFeeDescriptionInvalid data type in setData: If this paper is accepted for publication, you will be asked to pay an Article Publication Fee to cover publications costs.key: publicationFeeNameInvalid data type in setData: Article Publicationkey: purchaseArticleFeeDescriptionInvalid data type in setData: The payment of this fee will enable you to view, download, and print this article.key: purchaseArticleFeeNameInvalid data type in setData: Purchase Articlekey: submissionFeeDescriptionInvalid data type in setData: Authors are required to pay an Article Submission Fee as part of the submission process to contribute to review costs.key: submissionFeeNameInvalid data type in setData: Article Submissionkey: contactEmailInvalid data type in setData: support@ajol.infokey: contactNameInvalid data type in setData: African Journals Onlinekey: privacyStatementInvalid data type in setData: <p>The names and email addresses entered here will be used exclusively for the stated purposes of AJOL. We take your privacy seriously and we protect your personal information, which will not be made available for any other purpose or to any other party without your permission, or unless legal obligation compels us to do so.</p>key: titleInvalid data type in setData: African Journals Onlinekey: abbreviationInvalid data type in setData: Med Jnl Zamkey: aboutInvalid data type in setData: <h3>Open Access Policy</h3>This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.<h3>Publication Scheduling</h3>3 issues per year<h3>General</h3><div style="font-weight:bold">Subscriptions: Hard copies</div><div id="about">The journal is published quarterly. The following rates are for four regular issues of the journal per year plus supplements. They include postage by air mail. Institutions and Individuals: Within Zambia: K210,000 Within the SADC Region: US450.00 Rest of Africa: US460.00 United Kingdom/Europe: US$65.00 United States: US$70.00</div>key: acronymInvalid data type in setData: MJZkey: authorGuidelinesInvalid data type in setData: <p>Correspondence <br>All manuscripts and queries regarding manuscripts should be sent to: The Editor Medical Journal of Zambia Editorial Office Dept. of Medicine Room 39 P/Bag RW 1X University Teaching Hospital, Lusaka Zambia. <br>Except for letters to the editor where only one copy is required, all other articles should be submitted in triplicate (i.e. three copies) and an electronic version preferably submitted as an attachment to an email. Additional illustrations and photographs are to be attached as JPEG documents. Authors from the University Teaching Hospital in Lusaka may find it quicker to submit their articles through the e-mail: MedJZambia@yahoo.com.</p>
<p>Manuscripts Papers should be clear, precise and logical. The Journal welcomes submissions in any of the following categories: original articles, review articles, short reports, case reports, letters to the editor, and conference reports, as well as articles of medico-political nature (e.g. points of view).<br>Papers describing a particular event (e.g. an outbreak of infectious disease) should be submitted as soon as possible after the event. <br>Original articles and review articles should not exceed 3000 words, including the references. <br>Short reports and articles submitted as points of view should not exceed 1000 words. <br>Letters to the editors should be concise, not exceed 500 words and should not be accompanied by more than one table or figure.</p>
<p>The paper must be typewritten, on one side of the paper only, double-spaced throughout with margins on both sides of at least 2.5cm (one inch). Words to appear in italics should be underlined. Headings should not be underlined.</p>
<p><strong>Copyright </strong><br>It is condition of publication in the journal that the author 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 Medical Journal of Zambia.</p>
<p><strong>Condition of Acceptance </strong><br>Articles are accepted for publication on condition that they are contributed solely to Medical Journal of Zambia. The editor cannot enter into correspondence about papers considered unsuitable for publication and the decision is final. Neither the editor nor the publishers accept responsibility for the views.</p>
<p><strong>Authorship </strong><br>The Journal advises potential authors to ensure that only individuals who have made a substantial contribution to the scientific (or otherwise) merit of the work are included on the authorship. Underserved or passive authorship is discouraged. The Journal will normally not accept more than six (6) authors per single paper. Papers not fulfilling this requirement will be returned for justification of authorship.</p>
<p>Papers should be sent out as follows: <br>1. Title page bearing title, all authors, initials, surnames, main degrees (up to two only) and the name and location of the institution where the work was done. <br>2. Abstract: This should briefly outline the content of the paper under the following headlines: objectives, design, main outcomes, measures, results and conclusions. <br>3. Introduction <br>4. Methods <br>5. Results <br>6. Discussions <br>7. Acknowledgement <br>8. References</p>
<p>Review articles and other contributions that may not easily comply with the above layout should have appropriate subheadings instead. Tables and figures should be kept to a minimum. Tables must be comprehensible without reference to the text. Reference should not be cited in the tables. Authors should indicate at approximately what point in the text the table should appear. Figures, graphs, drawings etc., should be on separate sheets, numbered and executed in black ink and given suitable legends. Illustrations and tables should be kept separate from the text.</p>
<p><strong>References</strong> <br>References should be in the order made in the text and numbered accordingly using figures (numbers). These numbers should be inserted at the end of the paper and should consist of the surnames and initials of all authors when six or less, when seven or more, list the first three and add the words et al, title of article, full name of Journal, year, volume, first and last page numbers, as follows: 1. Ng’andu, N.H. and Watts, T.E. Child growth and breast feeding in Urban Zambia. Journal of Epidemiology and Community Health 1992; 44:281-285. 2. For books, names and initials of all author, the full title, place of publication, publishers, year of publication and page number should be given. Authors should personally verify the accuracy of every reference before submitting the paper for publication and should ensure that the listed references correspond exactly to those in the text.</p>
<p>A checklist for authors and contributors <br>• Must ensure you have submitted three copies of the manuscript. <br>• Be sure you have used the referencing style of the journal. <br>• Make sure every legends for illustrations are clearly written. <br>• Illustrations must be of good quality, unmounted glossy prints, usually 17x173mm, or attached as JPEG documents electronically. <br>• Has a colleague assessed your paper before submitting it? <br>• Take time to go through the instructions for authors and assess where your manuscript stands.</p>key: contactAffiliationInvalid data type in setData: University Teaching Hospital, Lusakakey: copyrightNoticeInvalid data type in setData: 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.key: descriptionInvalid data type in setData: <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>key: editorialTeamInvalid data type in setData: <div style="font-weight:bold">Editorial Office Details</div><div id="editorialTeam">Dept of Medicine Room 39 University Teaching Hospital Lusaka Postal Address P/Bag RW 1X Lusaka Zambia</div>key: licenseTermsInvalid data type in setData: 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.key: lockssLicenseInvalid data type in setData: This journal utilizes the LOCKSS system to create a distributed archiving system among participating libraries and permits those libraries to create permanent archives of the journal for purposes of preservation and restoration. <a href="http://lockss.org/">More...</a>key: membershipFeeDescriptionInvalid data type in setData: The payment of this fee will enroll you as a member in this association for one year and provide you with free access to this journal.key: membershipFeeNameInvalid data type in setData: Association Membershipkey: nameInvalid data type in setData: Medical Journal of Zambiakey: openAccessPolicyInvalid data type in setData: This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.key: privacyStatementInvalid data type in setData: The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.key: publicationFeeDescriptionInvalid data type in setData: If this paper is accepted for publication, you will be asked to pay an Article Publication Fee to cover publications costs.key: publicationFeeNameInvalid data type in setData: Article Publicationkey: purchaseArticleFeeDescriptionInvalid data type in setData: The payment of this fee will enable you to view, download, and print this article.key: purchaseArticleFeeNameInvalid data type in setData: Purchase Articlekey: submissionFeeDescriptionInvalid data type in setData: Authors are required to pay an Article Submission Fee as part of the submission process to contribute to review costs.key: submissionFeeNameInvalid data type in setData: Article Submissionkey: acronymInvalid data type in setData: AJOLkey: additionalHomeContentInvalid data type in setData: <h2>Welcome to African Journals Online (AJOL)!</h2>
<p>Researchers and policy-makers need access to contextually-relevant quality research publications from Africa in order to develop solutions to address the continent’s challenges in health, education, climate change &amp; under-development.</p>
<h3><strong>AJOL</strong>, the indexing platform of quality African-published scholarly journals, is a Non-Profit Organisation that (since 1998) works to increase global &amp; continental online access, awareness, quality &amp; use of African-published, peer-reviewed research.</h3>key: authorInformationInvalid data type in setData: Interested in submitting to this journal? We recommend that you review the <a href="http://www.ajol.info/ajol/about">About the Journal</a> page for the journal's section policies, as well as the <a href="http://www.ajol.info/ajol/about/submissions#authorGuidelines">Author Guidelines</a>. Authors need to <a href="http://www.ajol.info/ajol/user/register">register</a> with the journal prior to submitting, or if already registered can simply <a href="http://www.ajol.info/index/login">log in</a> and begin the 5 step process.key: contactAffiliationInvalid data type in setData: African Journals OnLinekey: copyrightNoticeInvalid data type in setData: Copyright for articles published in this journal is retained by the journal.key: librarianInformationInvalid data type in setData: We encourage research librarians to list this journal among their library's electronic journal holdings. As well, it may be worth noting that this journal's open source publishing system is suitable for libraries to host for their faculty members to use with journals they are involved in editing (see <a href="http://pkp.sfu.ca/ojs">Open Journal Systems</a>).key: licenseTermsInvalid data type in setData: Copyright for articles published in this journal is retained by the journal.key: lockssLicenseInvalid data type in setData: This journal utilizes the LOCKSS system to create a distributed archiving system among participating libraries and permits those libraries to create permanent archives of the journal for purposes of preservation and restoration. <a href="http://lockss.org/">More...</a>key: membershipFeeDescriptionInvalid data type in setData: The payment of this fee will enroll you as a member in this association for one year and provide you with free access to this journal.key: membershipFeeNameInvalid data type in setData: Association Membershipkey: nameInvalid data type in setData: African Journals Onlinekey: pageFooterInvalid data type in setData: <p style="text-align: center;"><a style="color: #fff;" href="mailto:info@ajol.info">info@ajol.info</a> <br /><br />CC-BY-SA African Journals Online (AJOL), with the exception of 3rd party content (3rd party content includes <em>inter alia</em> all journal content accessible on or via AJOL. Re-use or sharing of AJOL-hosted journal abstracts and full text articles is not nor has ever been legally permitted unless the journal/s' and/or article/s' displayed copyright and/or license explicitly permits it, or without specific written direct permission from journal/s and/or their publishing entity/ies and/or article author/s if the author/s hold copyright) <br /><br />African Journals Online (RF) S.A. Non Profit Company (NPC) Registration Number: 2005/033363/08</p>
key: privacyStatementInvalid data type in setData: The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.key: publicationFeeDescriptionInvalid data type in setData: If this paper is accepted for publication, you will be asked to pay an Article Publication Fee to cover publications costs.key: publicationFeeNameInvalid data type in setData: Article Publicationkey: purchaseArticleFeeDescriptionInvalid data type in setData: The payment of this fee will enable you to view, download, and print this article.key: purchaseArticleFeeNameInvalid data type in setData: Purchase Articlekey: readerInformationInvalid data type in setData: We encourage readers to sign up for the publishing notification service for this journal. Use the <a href="http://www.ajol.info/ajol/user/register">Register</a> link at the top of the homepage for the journal. This registration will result in the reader receiving the Table of Contents by email for each new issue of the journal. This list also allows the journal to claim a certain level of support or readership. See the journal's <a href="http://www.ajol.info/ajol/about/submissions#privacyStatement">Privacy Statement</a> which assures readers that their name and email address will not be used for other purposes.key: submissionFeeDescriptionInvalid data type in setData: Authors are required to pay an Article Submission Fee as part of the submission process to contribute to review costs.key: submissionFeeNameInvalid data type in setData: Article Submissionkey: abbreviationInvalid data type in setData: Med Jnl Zamkey: aboutInvalid data type in setData: <h3>Open Access Policy</h3>This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.<h3>Publication Scheduling</h3>3 issues per year<h3>General</h3><div style="font-weight:bold">Subscriptions: Hard copies</div><div id="about">The journal is published quarterly. The following rates are for four regular issues of the journal per year plus supplements. They include postage by air mail. Institutions and Individuals: Within Zambia: K210,000 Within the SADC Region: US450.00 Rest of Africa: US460.00 United Kingdom/Europe: US$65.00 United States: US$70.00</div>key: acronymInvalid data type in setData: MJZkey: authorGuidelinesInvalid data type in setData: <p>Correspondence <br>All manuscripts and queries regarding manuscripts should be sent to: The Editor Medical Journal of Zambia Editorial Office Dept. of Medicine Room 39 P/Bag RW 1X University Teaching Hospital, Lusaka Zambia. <br>Except for letters to the editor where only one copy is required, all other articles should be submitted in triplicate (i.e. three copies) and an electronic version preferably submitted as an attachment to an email. Additional illustrations and photographs are to be attached as JPEG documents. Authors from the University Teaching Hospital in Lusaka may find it quicker to submit their articles through the e-mail: MedJZambia@yahoo.com.</p>
<p>Manuscripts Papers should be clear, precise and logical. The Journal welcomes submissions in any of the following categories: original articles, review articles, short reports, case reports, letters to the editor, and conference reports, as well as articles of medico-political nature (e.g. points of view).<br>Papers describing a particular event (e.g. an outbreak of infectious disease) should be submitted as soon as possible after the event. <br>Original articles and review articles should not exceed 3000 words, including the references. <br>Short reports and articles submitted as points of view should not exceed 1000 words. <br>Letters to the editors should be concise, not exceed 500 words and should not be accompanied by more than one table or figure.</p>
<p>The paper must be typewritten, on one side of the paper only, double-spaced throughout with margins on both sides of at least 2.5cm (one inch). Words to appear in italics should be underlined. Headings should not be underlined.</p>
<p><strong>Copyright </strong><br>It is condition of publication in the journal that the author 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 Medical Journal of Zambia.</p>
<p><strong>Condition of Acceptance </strong><br>Articles are accepted for publication on condition that they are contributed solely to Medical Journal of Zambia. The editor cannot enter into correspondence about papers considered unsuitable for publication and the decision is final. Neither the editor nor the publishers accept responsibility for the views.</p>
<p><strong>Authorship </strong><br>The Journal advises potential authors to ensure that only individuals who have made a substantial contribution to the scientific (or otherwise) merit of the work are included on the authorship. Underserved or passive authorship is discouraged. The Journal will normally not accept more than six (6) authors per single paper. Papers not fulfilling this requirement will be returned for justification of authorship.</p>
<p>Papers should be sent out as follows: <br>1. Title page bearing title, all authors, initials, surnames, main degrees (up to two only) and the name and location of the institution where the work was done. <br>2. Abstract: This should briefly outline the content of the paper under the following headlines: objectives, design, main outcomes, measures, results and conclusions. <br>3. Introduction <br>4. Methods <br>5. Results <br>6. Discussions <br>7. Acknowledgement <br>8. References</p>
<p>Review articles and other contributions that may not easily comply with the above layout should have appropriate subheadings instead. Tables and figures should be kept to a minimum. Tables must be comprehensible without reference to the text. Reference should not be cited in the tables. Authors should indicate at approximately what point in the text the table should appear. Figures, graphs, drawings etc., should be on separate sheets, numbered and executed in black ink and given suitable legends. Illustrations and tables should be kept separate from the text.</p>
<p><strong>References</strong> <br>References should be in the order made in the text and numbered accordingly using figures (numbers). These numbers should be inserted at the end of the paper and should consist of the surnames and initials of all authors when six or less, when seven or more, list the first three and add the words et al, title of article, full name of Journal, year, volume, first and last page numbers, as follows: 1. Ng’andu, N.H. and Watts, T.E. Child growth and breast feeding in Urban Zambia. Journal of Epidemiology and Community Health 1992; 44:281-285. 2. For books, names and initials of all author, the full title, place of publication, publishers, year of publication and page number should be given. Authors should personally verify the accuracy of every reference before submitting the paper for publication and should ensure that the listed references correspond exactly to those in the text.</p>
<p>A checklist for authors and contributors <br>• Must ensure you have submitted three copies of the manuscript. <br>• Be sure you have used the referencing style of the journal. <br>• Make sure every legends for illustrations are clearly written. <br>• Illustrations must be of good quality, unmounted glossy prints, usually 17x173mm, or attached as JPEG documents electronically. <br>• Has a colleague assessed your paper before submitting it? <br>• Take time to go through the instructions for authors and assess where your manuscript stands.</p>key: contactAffiliationInvalid data type in setData: University Teaching Hospital, Lusakakey: copyrightNoticeInvalid data type in setData: 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.key: descriptionInvalid data type in setData: <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>key: editorialTeamInvalid data type in setData: <div style="font-weight:bold">Editorial Office Details</div><div id="editorialTeam">Dept of Medicine Room 39 University Teaching Hospital Lusaka Postal Address P/Bag RW 1X Lusaka Zambia</div>key: licenseTermsInvalid data type in setData: 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.key: lockssLicenseInvalid data type in setData: This journal utilizes the LOCKSS system to create a distributed archiving system among participating libraries and permits those libraries to create permanent archives of the journal for purposes of preservation and restoration. <a href="http://lockss.org/">More...</a>key: membershipFeeDescriptionInvalid data type in setData: The payment of this fee will enroll you as a member in this association for one year and provide you with free access to this journal.key: membershipFeeNameInvalid data type in setData: Association Membershipkey: nameInvalid data type in setData: Medical Journal of Zambiakey: openAccessPolicyInvalid data type in setData: This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.key: privacyStatementInvalid data type in setData: The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.key: publicationFeeDescriptionInvalid data type in setData: If this paper is accepted for publication, you will be asked to pay an Article Publication Fee to cover publications costs.key: publicationFeeNameInvalid data type in setData: Article Publicationkey: purchaseArticleFeeDescriptionInvalid data type in setData: The payment of this fee will enable you to view, download, and print this article.key: purchaseArticleFeeNameInvalid data type in setData: Purchase Articlekey: submissionFeeDescriptionInvalid data type in setData: Authors are required to pay an Article Submission Fee as part of the submission process to contribute to review costs.key: submissionFeeNameInvalid data type in setData: Article Submissionkey: coverPageDescriptionInvalid data type in setData: key: descriptionInvalid data type in setData: key: hideCoverPageArchivesInvalid data type in setData: 0key: hideCoverPageCoverInvalid data type in setData: 0key: showCoverPageInvalid data type in setData: 0key: titleInvalid data type in setData: key: nameInvalid data type in setData: Article Textkey: nameInvalid data type in setData: Texte de l'articlekey: abstractInvalid data type in setData: No Abstract.key: titleInvalid data type in setData: Heart failure in Zambia: Evidence for Improving Clinical Practicekey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Gomakey: givenNameInvalid data type in setData: FMkey: submissionLanguageInvalid data type in setData: enkey: abstractInvalid data type in setData: <p><em><strong>Background</strong></em>: Heart failure is a major public health problem and has been recognized as an important cause of morbidity and mortality for several years. It is one of the leading non-infectious causes of death among hospitalized patients at the University Teaching Hospital (UTH) in Lusaka, Zambia. This study aimed to investigate the predictors of 30-day mortality in heart failure patients admitted to the medical wards at the UTH using routinely obtained clinical data.</p><p><em><strong>Methods</strong></em>: We enrolled 390 heart failure patients and followed them up over a period of 30 days. Data collected included demographic characteristics (age, sex), medication use and co-morbidities (hypertension, diabetes  mellitus, Human Immunodeficiency Virus (HIV) infection). Clinical data included vital signs, blood urea, serum sodium, serum potassium, serum creatinine, and haemoglobin level. Trans-thoracic echocardiographs and electrocardiographs were also done to determine left ventricular ejection fraction (LVEF) and to check for the presence of arrhythmias. Patients were dichotomized into those with preserved (LVEF&gt;=40 percent) and reduced (LVEF&lt; 40 percent) systolic function. Recruited patients were then prospectively followed up to determine outcome by day 30 (i.e. dead or alive). Cox proportion Hazard regression analysis (on Epi Info software version 3.5.3) was used to analyse the effect of each of these parameters on outcome.</p><p><strong><em>Results</em></strong>: Of the recruited patients, 59% were female (95% CI 54-64). The median age was 50 years (IQR 33-68). 138 patients (35%, 95% CI 31-40) died within 30 days of admission. 94 (68%) of these deaths occurred  in-hospital. The factors shown to be independent predictors of death onmultivariate logistic regression analysis were LVEF&lt;40 percent (OR=2.86, 95%CI 1.68- 4.87), NYHA class IV (OR=2.15, 95%CI 1.27- 3.64),serum urea above 15mmol/L (OR=2.48, 95%CI 1.07-5.70), and haemoglobin level below 12g/dL (OR=1.79, 95%CI 1.11- 2.89).The additional factor associated with increased risk of mortality on univariate analysis wassystolic blood pressure below 115mmHg (OR=1.63, 95%CI 1.05- 2.51). However, serum creatinine (OR=1.49, 95%CI  0.49-4.48) and HIV  seropositivity (OR=0.96, 95% CI 0.53-1.72)had no bearing on the risk of death in this patient population.</p><p><em><strong>Conclusions</strong></em>: Left ventricular ejection fraction &lt;40 percent, New York Heart Association class IV, serum urea above 15mmol/L, haemoglobin level below 12g/dLand systolic blood pressure below 115mmHg are predictors of poor 30-day outcome in hospitalised heart failure patients.</p>key: titleInvalid data type in setData: Factors associated with Mortality in Adults admitted with Heart Failure at the University Teaching Hospital in Lusaka, Zambiakey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Chansakey: givenNameInvalid data type in setData: Pkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Lakhikey: givenNameInvalid data type in setData: Skey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Andrewskey: givenNameInvalid data type in setData: Bkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Kalinchenkokey: givenNameInvalid data type in setData: Skey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Sakrkey: givenNameInvalid data type in setData: Rkey: submissionLanguageInvalid data type in setData: enkey: abstractInvalid data type in setData: <p><em><strong>Background</strong></em>: Gastric cancer poses a significant global health burden. It is the second most common cause of cancer death worldwide and the ninth leading cause of cancer mortality in Zambia, at a rate of 3.8/100,000; comparable to USA (2/100,000) and UK (3.4/100,000). Survival data on gastric malignancy in Zambia is not known.<br /><br /><strong><em>Objectives</em></strong>: To provide preliminary survival rates of patients with histologically proven gastric adenocarcinoma in Zambia.</p><p><br /><em><strong>Study Design</strong></em>: Using our prospective gastric cancer research database, we conducted a retrospective audit of patients diagnosed with gastric cancer at the University Teaching Hospital, Zambia, from June 2010 until January 2012. We contacted patients or their relatives using phone numbers provided at time of enrollment.</p><p><em><strong>Main Outcomes</strong></em>: We reviewed age, sex, demographic data (income, education), body mass index, symptoms, duration of symptoms, treatment (surgery, chemotherapy, radiotherapy or combination) and survival outcome.  Analysis was performed using Kaplan-Meier models and log rank test.<br /><em><strong></strong></em></p><p><em><strong>Results</strong></em>: Fifty one patients were diagnosed with gastric adenocarcinoma during the study period, but follow-up data were available for 50. Median survival was 142 days. Age, sex, income, education, BMI, tumor location, and treatment modality were not significantly associated with overall survival. In Cox regression models, covariates associated with survival were a history of regular alcohol intake (HR 0.49, 95%CI 0.26,0.92; P=0.025) and intestinal type cancer histology (HR 0.40, 95%CI 0.19,0.83; P=0.01).<br /><em><strong></strong></em></p><p><em><strong>Conclusion</strong></em>: Prognosis of newly diagnosed gastric cancer in Zambia is poor with significant mortality within 1 year<br />of diagnosis, particularly among patients with weight loss and dysphagia.</p>key: titleInvalid data type in setData: Gastric Malignancy Survival in Zambia, Southern Africa: A two year follow up studykey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Asombangkey: givenNameInvalid data type in setData: AWkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Kayambakey: givenNameInvalid data type in setData: Vkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Turner-Mosskey: givenNameInvalid data type in setData: Ekey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Bandakey: givenNameInvalid data type in setData: Lkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Colditzkey: givenNameInvalid data type in setData: Gkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Mudendakey: givenNameInvalid data type in setData: Vkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Zulukey: givenNameInvalid data type in setData: Rkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Sinkalakey: givenNameInvalid data type in setData: Ekey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Kellykey: givenNameInvalid data type in setData: Pkey: submissionLanguageInvalid data type in setData: enkey: abstractInvalid data type in setData: <p><em><strong>Background</strong></em>: In Zambia, at least eighty per cent (80%) of the adult population does not know about their HIV<br />status<sup>11</sup>. In order to increase uptake of HIV testing, Ministry of Health introduced provider- initiated HIV counseling and testing for individuals attending health facilities in 200812. However, since the policy was introduced, there has been no research evidence on how the community perceives the policy and how it has influenced their health seeking behavior.</p><p><em><strong>Objectives</strong></em>: The aim of this study was to explore community perspectives on provider-initiated HIV testing.</p><p><em><strong>Design</strong></em>: The study was a cross-sectional descriptive design. The study used both qualitative and quantitative approaches. Multistage sampling was used to select households for interviews. Adults above 18 years of age were interviewed from the selected households using a structured interview questionnaire. The questionnaire was translated into the local language to enhance understanding of the subject. Purposive sampling was instituted to  select key informants for in-depth interviews. Logistic regression was applied to determine  independent predictors  for supporting provider- initiated HIV testing. In-depth interviews were translated and transcribed into computer files; common themes were identified, after which data was categorized using the Nvivo statistical package.</p><p><em><strong>Results</strong></em>: A total of 809 respondents and 12 (twelve) key informants participated in the study. The age range for the cohort was 18-80 years, with mean age of 35.8 years. Of the whole study population, 42.8% were males while 57.2% were females.The study found that the majority of respondents (61.9%) were not aware of the  providerinitiated HIV  testing policy. Despite this scenario, the majority (80.3%) of respondents and all the key informants supported the  policy. Furthermore, most (89.5%) respondents indicated that they would accept to be tested if they were to be  hospitalized. Support for the policy was on the premise that the community has realized the importance of HIV  testing as an entry point to HIV care, treatment, and support.</p><p><em><strong>Conclusion</strong></em>: The Macha community is in support of provider –initiated HIV testing policy although awareness of  the policy is low. It is evident that the majority of respondents have been able to observe benefits associated with  testing through the ART services going on at the hospital. However, there was more preference for  communitybased voluntary counseling and testing. According to the community, mobile VCT services were more preferred because they saved costs of travel to the health facility and reduced stigma.</p>key: titleInvalid data type in setData: Community Perspectives Towards Provider- Initiated Testing for HIV in Machakey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Sitalikey: givenNameInvalid data type in setData: Dkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Nzalakey: givenNameInvalid data type in setData: SHkey: submissionLanguageInvalid data type in setData: enkey: abstractInvalid data type in setData: <p><strong><em>Background</em></strong>: Congenital rubella syndrome (CRS) caused by rubella infection in uterine, is a major public health problem among women of child bearing age as it causes serious complications including foetal death or  abnormalities including cardiovascular, ophthalmologic, respiratory and hearing impairment. Though there is  evidence of rubella infection amongst the population under the expanded programme on immunization (epi)  surveillance programme, there is no documented evidence of laboratory confirmed congenital rubella syndrome  cases in Zambia. A report is given on four cases of CRS that were identified and confirmed during routine activities of the national measles surveillance program in Zambia. Clinical data on the symptomatic cases were collected and  serum samples tested for rubella IgM to confirm the cases.</p><p><em><strong>Case presentation</strong></em>: The first confirmed case was a baby girl presented to the Neonatal Intensive Care unit of the University Teaching Hospital for low birth weight and hypothermia. At seven weeks, the girl was found to have  cataracts, spleno-hepatomegaly, microcephaly, and patent ductus arteriosus (PDA). The baby tested positive to  rubella IgM antibodies. The second case was a baby boy who was first seen at the University Teaching Hospital at  three weeks and on examination was found to have bilateral cataracts, congenital heart disease and microcephaly.  Rubella Immunoglobulin M (IgM) results were positive. The third case, a girl, was seen at twelve weeks and brought in for slow growth rate. On examination, the girl was found to have bilateral cataracts,  microcephaly and  developmental delay. The fourth case is a girl who was brought to the hospital for failure to thrive, tachypnea and  fever. On further investigations there was evidence of cataracts, patent ductus arteriosus. At eight weeks, she tested  positive for rubella IgM antibodies.</p><p><em><strong>Conclusion</strong></em>: The clinical symptoms and laboratory evidence of rubella infection confirmed congenital rubella syndrome in the four patients. There is an urgent need for surveillance of congenital rubella syndrome and a  baseline rubella sero-prevalence survey in Zambia in order to determine the burden of the disease and use this  data to direct policy in terms of interventions for supportive treatment, control and possible elimination of rubella  infection through immunization with measlesrubella vaccine.</p><p><strong>Keywords</strong>: Congenital Rubella Syndrome; Confirmed; Measles-Rubella vaccine; Lusaka, Zambia</p>key: titleInvalid data type in setData: Laboratory-confirmed Congenital Rubella Syndrome at the University Teaching Hospital in Lusaka, Zambia-Case Reportskey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Mazaba-Liwewekey: givenNameInvalid data type in setData: MLkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Mtajakey: givenNameInvalid data type in setData: Akey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Chabalakey: givenNameInvalid data type in setData: Ckey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Sinyangwekey: givenNameInvalid data type in setData: Skey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Babaniyikey: givenNameInvalid data type in setData: Okey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Monzekey: givenNameInvalid data type in setData: Mkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Siziyakey: givenNameInvalid data type in setData: Skey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Michelokey: givenNameInvalid data type in setData: Ckey: submissionLanguageInvalid data type in setData: enkey: abstractInvalid data type in setData: <p><em><strong>Objectives</strong></em>: To demonstrate the benefits of performing a split skin graft within 15 days post burn and explore the<br />differences in duration of hospital stay, occurrence of infection and contracture formation in comparison to standard care currently provided at U.T.H (late or non split skin graft).</p><p><br /><em><strong>Design</strong></em>: This was a prospective, non-randomized, interventional study involving patients with deep partial thickness burn wounds at UTH. Study subjects were to either receive an early-delayed skin graft, or the standard treatment at the time based on the surgical firm to which they were admitted.</p><p><em><strong>Results</strong></em>: Forty-three (55.1%) patients allocated to receive an early-delayed ssg while 35 (44.9%) were assigned to the late or non-ssg group. The proportion of males was 23 (29.5%) in the early-delayed group and 22 (28.2%) in the late or non ssg group while the proportion of females was 20 (25.6%) in the early-delayed group and 13 (16.7%) in the late or non ssg group. The participants' age range was 2 months to 84 years. Forty-nine (62.8%) were 5 years and below, eight (10.3%) were aged 6-10 years, ten (12.8%) were aged 11-20 years, and eleven (14.1%) were aged 21 and above years. The following were the main causes of burns, in their order of frequency, hot water (57%), flames (27%), hot food (i.e. cooking oil, porridge, beans [14%]), and chemicals (1%). In both groups the most common cause for burns was hot water, 19 (24%) in the earlydelayed skin graft group and 26 (33%) in the late or non ssg group. In forty seven (60%) patients burns were observed to affect multiple regions of the body. Mean total body surface area burn was 14%. Overall, 73 patients (93.6%) came from within Lusaka. It was also noted that 39(50%) were self referrals. Overall, 86% presented to the hospital within 24 hrs but  despite early presentation participants were reluctant to recieve an early skin graft due to lack of understanding of the procedure. Findings of this study found that at significance levels of 0.05 in the late or non SSG group hospital stay was significantly longer, (U = 305.500; p = 0.001) and infection higher (Chi Square = 4.510; p = 0.034).No significant difference was noted in contracture formation in the two groups (Chi square = 0.999; p = 0.258).</p><p><em><strong>Conclusions</strong></em>: Early–delayed split skin graft was found to statistically significantly reduce length of stay and occurence of infection as opposed to late or non ssg.No statistically significant relation could be established for occurence of contractures due to loss in follow up of patient valuable information was lost. This study shows that  even if early delayed SSG were to be offered at UTH there is need to carry out awareness campaigns to change  peoples attitudes towards the surgical procedure (SSG). This is an approved treatment world-wide which has not  gained wide acceptance amongst patients presenting to U.T.H that participated in this study. Patient attitudes and perceptions need to be changed as SSG currently is not seen as a curative treatment but as added injury to an  already injured patient.This study showed that SSG is possible and the few patients who underwent early grafting  showed good outcomes, shorter hospital stay and lower infection rates. Reduction in contracture formation may  have been determined if follow up was achieved.</p>key: titleInvalid data type in setData: A comparative study of early-delayed skin grafting and late or non-grafting of deep partial thickness burns at the University Teaching Hospitalkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Maimbokey: givenNameInvalid data type in setData: Mkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Jovickey: givenNameInvalid data type in setData: Gkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Odimbakey: givenNameInvalid data type in setData: BFKkey: submissionLanguageInvalid data type in setData: enkey: abstractInvalid data type in setData: <p><em><strong>Background</strong></em>: Mid trimester abortion constitutes 10-15% of all induced abortions worldwide and accounts for the majority of complications. In Africa, studies demonstrating the proportion of second trimester abortions are few.  However to appropriately intervene with a view to reducing the morbidity and mortality due to mid trimester   abortions, the determinants in our setting must be established as well as the outcomes of uterine evacuation in  this trimester. The aim of this study was to explore the determinants and outcomes of second trimester abortions at UTH.</p><p><strong><em>Design</em></strong>: Cross sectional non interventional descriptive study.</p><p><em><strong>Setting</strong></em>: University Teaching Hospital, a tertiary referral hospital in Lusaka, Zambia</p><p><em><strong>Population</strong></em>: Pregnant women requiring second trimester abortion care.</p><p><em><strong>Methods</strong></em>: A total of 145 second trimester cases were seen, involving women aged 13-46 years of age either<br />requesting termination of pregnancy or presenting with spontaneous or induced abortion. The enrolled study<br />participants all underwent a standard clinical assessment during which their respective clinical findings were<br />recorded on data sheets. Data analysis was done using SPSS version 17.</p><p><em><strong>Results</strong></em>: The point prevalence of second trimester abortion was 15.3%. The mean frequency of abortion per patient was 1. The index abortion was for a first pregnancy in 84% of the women. Out of 145 women who were  admitted 119 (82.1%) were linked to spontaneous abortions, 16(11%) with medically/surgically induced abortion  and 10(6.9%) with self-induced abortions. More women, 128(88%) were not using some form of contraception to  avoid pregnancy. Few, 17(12%) actually used some form of contraception prior to index pregnancy. Five (3.4%)  out of 26 who had induced abortion had desired pregnancy. Of the delay factors, the most frequent was conflict  with partner. Amongst those who had spontaneous abortion, illness was reported as most frequent determinant  (49.7%). It was observed that there was no statistically significant association between seeking care and with any  delay factors. With regard to standard of care or health system factors, overall 89% were provided with  ppropriate uterine evacuation method while the rest were not. Fifty percent did not receive analgesia. The mean time   between expulsion of fetus and uterine evacuation was 4.31 hours. Complications noted included uterine  perforation, hemorrhage, cervical or vaginal lacerations, shock and even death.</p><p><em><strong>Conclusion</strong></em>: The determinants of the second trimester abortion cases at the University Teaching Hospital are social, economic, health system factors, trauma, illness and unknown factors. The outcomes of second trimester  abortion in terms of complications are varied. These are due to patient factors and methods used for uterine  evacuation. The outcomes included uncomplicated complete abortion, retained products of conception,   haemorrhage, uterine perforation, pain, shock, infection, lacerations, delayed vaginal bleeding and death. The  methods of uterine evacuation varied from patient to patient but the overall outcome of the patient was not   significantly affected by this.</p><p><strong>Key Words</strong>: Second trimester,Abortion, determinants and outcomes.</p>key: titleInvalid data type in setData: The Determinants and Outcomes of Second Trimester Abortion at the University Teaching Hospitalkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Muyunikey: givenNameInvalid data type in setData: Mkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Vwalikakey: givenNameInvalid data type in setData: Bkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Ahmedkey: givenNameInvalid data type in setData: Ykey: submissionLanguageInvalid data type in setData: enkey: coverPageDescriptionInvalid data type in setData: key: descriptionInvalid data type in setData: key: hideCoverPageArchivesInvalid data type in setData: 0key: hideCoverPageCoverInvalid data type in setData: 0key: showCoverPageInvalid data type in setData: 0key: titleInvalid data type in setData: key: abstractInvalid data type in setData: <p><strong><em>Background</em></strong>: Congenital rubella syndrome (CRS) caused by rubella infection in uterine, is a major public health problem among women of child bearing age as it causes serious complications including foetal death or  abnormalities including cardiovascular, ophthalmologic, respiratory and hearing impairment. Though there is  evidence of rubella infection amongst the population under the expanded programme on immunization (epi)  surveillance programme, there is no documented evidence of laboratory confirmed congenital rubella syndrome  cases in Zambia. A report is given on four cases of CRS that were identified and confirmed during routine activities of the national measles surveillance program in Zambia. Clinical data on the symptomatic cases were collected and  serum samples tested for rubella IgM to confirm the cases.</p><p><em><strong>Case presentation</strong></em>: The first confirmed case was a baby girl presented to the Neonatal Intensive Care unit of the University Teaching Hospital for low birth weight and hypothermia. At seven weeks, the girl was found to have  cataracts, spleno-hepatomegaly, microcephaly, and patent ductus arteriosus (PDA). The baby tested positive to  rubella IgM antibodies. The second case was a baby boy who was first seen at the University Teaching Hospital at  three weeks and on examination was found to have bilateral cataracts, congenital heart disease and microcephaly.  Rubella Immunoglobulin M (IgM) results were positive. The third case, a girl, was seen at twelve weeks and brought in for slow growth rate. On examination, the girl was found to have bilateral cataracts,  microcephaly and  developmental delay. The fourth case is a girl who was brought to the hospital for failure to thrive, tachypnea and  fever. On further investigations there was evidence of cataracts, patent ductus arteriosus. At eight weeks, she tested  positive for rubella IgM antibodies.</p><p><em><strong>Conclusion</strong></em>: The clinical symptoms and laboratory evidence of rubella infection confirmed congenital rubella syndrome in the four patients. There is an urgent need for surveillance of congenital rubella syndrome and a  baseline rubella sero-prevalence survey in Zambia in order to determine the burden of the disease and use this  data to direct policy in terms of interventions for supportive treatment, control and possible elimination of rubella  infection through immunization with measlesrubella vaccine.</p><p><strong>Keywords</strong>: Congenital Rubella Syndrome; Confirmed; Measles-Rubella vaccine; Lusaka, Zambia</p>key: titleInvalid data type in setData: Laboratory-confirmed Congenital Rubella Syndrome at the University Teaching Hospital in Lusaka, Zambia-Case Reportskey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Mazaba-Liwewekey: givenNameInvalid data type in setData: MLkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Mtajakey: givenNameInvalid data type in setData: Akey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Chabalakey: givenNameInvalid data type in setData: Ckey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Sinyangwekey: givenNameInvalid data type in setData: Skey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Babaniyikey: givenNameInvalid data type in setData: Okey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Monzekey: givenNameInvalid data type in setData: Mkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Siziyakey: givenNameInvalid data type in setData: Skey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Michelokey: givenNameInvalid data type in setData: Ckey: submissionLanguageInvalid data type in setData: enkey: abstractInvalid data type in setData: <p><em><strong>Background</strong></em>: Mid trimester abortion constitutes 10-15% of all induced abortions worldwide and accounts for the majority of complications. In Africa, studies demonstrating the proportion of second trimester abortions are few.  However to appropriately intervene with a view to reducing the morbidity and mortality due to mid trimester   abortions, the determinants in our setting must be established as well as the outcomes of uterine evacuation in  this trimester. The aim of this study was to explore the determinants and outcomes of second trimester abortions at UTH.</p><p><strong><em>Design</em></strong>: Cross sectional non interventional descriptive study.</p><p><em><strong>Setting</strong></em>: University Teaching Hospital, a tertiary referral hospital in Lusaka, Zambia</p><p><em><strong>Population</strong></em>: Pregnant women requiring second trimester abortion care.</p><p><em><strong>Methods</strong></em>: A total of 145 second trimester cases were seen, involving women aged 13-46 years of age either<br />requesting termination of pregnancy or presenting with spontaneous or induced abortion. The enrolled study<br />participants all underwent a standard clinical assessment during which their respective clinical findings were<br />recorded on data sheets. Data analysis was done using SPSS version 17.</p><p><em><strong>Results</strong></em>: The point prevalence of second trimester abortion was 15.3%. The mean frequency of abortion per patient was 1. The index abortion was for a first pregnancy in 84% of the women. Out of 145 women who were  admitted 119 (82.1%) were linked to spontaneous abortions, 16(11%) with medically/surgically induced abortion  and 10(6.9%) with self-induced abortions. More women, 128(88%) were not using some form of contraception to  avoid pregnancy. Few, 17(12%) actually used some form of contraception prior to index pregnancy. Five (3.4%)  out of 26 who had induced abortion had desired pregnancy. Of the delay factors, the most frequent was conflict  with partner. Amongst those who had spontaneous abortion, illness was reported as most frequent determinant  (49.7%). It was observed that there was no statistically significant association between seeking care and with any  delay factors. With regard to standard of care or health system factors, overall 89% were provided with  ppropriate uterine evacuation method while the rest were not. Fifty percent did not receive analgesia. The mean time   between expulsion of fetus and uterine evacuation was 4.31 hours. Complications noted included uterine  perforation, hemorrhage, cervical or vaginal lacerations, shock and even death.</p><p><em><strong>Conclusion</strong></em>: The determinants of the second trimester abortion cases at the University Teaching Hospital are social, economic, health system factors, trauma, illness and unknown factors. The outcomes of second trimester  abortion in terms of complications are varied. These are due to patient factors and methods used for uterine  evacuation. The outcomes included uncomplicated complete abortion, retained products of conception,   haemorrhage, uterine perforation, pain, shock, infection, lacerations, delayed vaginal bleeding and death. The  methods of uterine evacuation varied from patient to patient but the overall outcome of the patient was not   significantly affected by this.</p><p><strong>Key Words</strong>: Second trimester,Abortion, determinants and outcomes.</p>key: titleInvalid data type in setData: The Determinants and Outcomes of Second Trimester Abortion at the University Teaching Hospitalkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Muyunikey: givenNameInvalid data type in setData: Mkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Vwalikakey: givenNameInvalid data type in setData: Bkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Ahmedkey: givenNameInvalid data type in setData: Ykey: submissionLanguageInvalid data type in setData: enkey: abstractInvalid data type in setData: <p><em><strong>Objectives</strong></em>: To demonstrate the benefits of performing a split skin graft within 15 days post burn and explore the<br />differences in duration of hospital stay, occurrence of infection and contracture formation in comparison to standard care currently provided at U.T.H (late or non split skin graft).</p><p><br /><em><strong>Design</strong></em>: This was a prospective, non-randomized, interventional study involving patients with deep partial thickness burn wounds at UTH. Study subjects were to either receive an early-delayed skin graft, or the standard treatment at the time based on the surgical firm to which they were admitted.</p><p><em><strong>Results</strong></em>: Forty-three (55.1%) patients allocated to receive an early-delayed ssg while 35 (44.9%) were assigned to the late or non-ssg group. The proportion of males was 23 (29.5%) in the early-delayed group and 22 (28.2%) in the late or non ssg group while the proportion of females was 20 (25.6%) in the early-delayed group and 13 (16.7%) in the late or non ssg group. The participants' age range was 2 months to 84 years. Forty-nine (62.8%) were 5 years and below, eight (10.3%) were aged 6-10 years, ten (12.8%) were aged 11-20 years, and eleven (14.1%) were aged 21 and above years. The following were the main causes of burns, in their order of frequency, hot water (57%), flames (27%), hot food (i.e. cooking oil, porridge, beans [14%]), and chemicals (1%). In both groups the most common cause for burns was hot water, 19 (24%) in the earlydelayed skin graft group and 26 (33%) in the late or non ssg group. In forty seven (60%) patients burns were observed to affect multiple regions of the body. Mean total body surface area burn was 14%. Overall, 73 patients (93.6%) came from within Lusaka. It was also noted that 39(50%) were self referrals. Overall, 86% presented to the hospital within 24 hrs but  despite early presentation participants were reluctant to recieve an early skin graft due to lack of understanding of the procedure. Findings of this study found that at significance levels of 0.05 in the late or non SSG group hospital stay was significantly longer, (U = 305.500; p = 0.001) and infection higher (Chi Square = 4.510; p = 0.034).No significant difference was noted in contracture formation in the two groups (Chi square = 0.999; p = 0.258).</p><p><em><strong>Conclusions</strong></em>: Early–delayed split skin graft was found to statistically significantly reduce length of stay and occurence of infection as opposed to late or non ssg.No statistically significant relation could be established for occurence of contractures due to loss in follow up of patient valuable information was lost. This study shows that  even if early delayed SSG were to be offered at UTH there is need to carry out awareness campaigns to change  peoples attitudes towards the surgical procedure (SSG). This is an approved treatment world-wide which has not  gained wide acceptance amongst patients presenting to U.T.H that participated in this study. Patient attitudes and perceptions need to be changed as SSG currently is not seen as a curative treatment but as added injury to an  already injured patient.This study showed that SSG is possible and the few patients who underwent early grafting  showed good outcomes, shorter hospital stay and lower infection rates. Reduction in contracture formation may  have been determined if follow up was achieved.</p>key: titleInvalid data type in setData: A comparative study of early-delayed skin grafting and late or non-grafting of deep partial thickness burns at the University Teaching Hospitalkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Maimbokey: givenNameInvalid data type in setData: Mkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Jovickey: givenNameInvalid data type in setData: Gkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Odimbakey: givenNameInvalid data type in setData: BFKkey: submissionLanguageInvalid data type in setData: enkey: abstractInvalid data type in setData: <p><em><strong>Background</strong></em>: In Zambia, at least eighty per cent (80%) of the adult population does not know about their HIV<br />status<sup>11</sup>. In order to increase uptake of HIV testing, Ministry of Health introduced provider- initiated HIV counseling and testing for individuals attending health facilities in 200812. However, since the policy was introduced, there has been no research evidence on how the community perceives the policy and how it has influenced their health seeking behavior.</p><p><em><strong>Objectives</strong></em>: The aim of this study was to explore community perspectives on provider-initiated HIV testing.</p><p><em><strong>Design</strong></em>: The study was a cross-sectional descriptive design. The study used both qualitative and quantitative approaches. Multistage sampling was used to select households for interviews. Adults above 18 years of age were interviewed from the selected households using a structured interview questionnaire. The questionnaire was translated into the local language to enhance understanding of the subject. Purposive sampling was instituted to  select key informants for in-depth interviews. Logistic regression was applied to determine  independent predictors  for supporting provider- initiated HIV testing. In-depth interviews were translated and transcribed into computer files; common themes were identified, after which data was categorized using the Nvivo statistical package.</p><p><em><strong>Results</strong></em>: A total of 809 respondents and 12 (twelve) key informants participated in the study. The age range for the cohort was 18-80 years, with mean age of 35.8 years. Of the whole study population, 42.8% were males while 57.2% were females.The study found that the majority of respondents (61.9%) were not aware of the  providerinitiated HIV  testing policy. Despite this scenario, the majority (80.3%) of respondents and all the key informants supported the  policy. Furthermore, most (89.5%) respondents indicated that they would accept to be tested if they were to be  hospitalized. Support for the policy was on the premise that the community has realized the importance of HIV  testing as an entry point to HIV care, treatment, and support.</p><p><em><strong>Conclusion</strong></em>: The Macha community is in support of provider –initiated HIV testing policy although awareness of  the policy is low. It is evident that the majority of respondents have been able to observe benefits associated with  testing through the ART services going on at the hospital. However, there was more preference for  communitybased voluntary counseling and testing. According to the community, mobile VCT services were more preferred because they saved costs of travel to the health facility and reduced stigma.</p>key: titleInvalid data type in setData: Community Perspectives Towards Provider- Initiated Testing for HIV in Machakey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Sitalikey: givenNameInvalid data type in setData: Dkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Nzalakey: givenNameInvalid data type in setData: SHkey: submissionLanguageInvalid data type in setData: enkey: abstractInvalid data type in setData: <p><em><strong>Background</strong></em>: Gastric cancer poses a significant global health burden. It is the second most common cause of cancer death worldwide and the ninth leading cause of cancer mortality in Zambia, at a rate of 3.8/100,000; comparable to USA (2/100,000) and UK (3.4/100,000). Survival data on gastric malignancy in Zambia is not known.<br /><br /><strong><em>Objectives</em></strong>: To provide preliminary survival rates of patients with histologically proven gastric adenocarcinoma in Zambia.</p><p><br /><em><strong>Study Design</strong></em>: Using our prospective gastric cancer research database, we conducted a retrospective audit of patients diagnosed with gastric cancer at the University Teaching Hospital, Zambia, from June 2010 until January 2012. We contacted patients or their relatives using phone numbers provided at time of enrollment.</p><p><em><strong>Main Outcomes</strong></em>: We reviewed age, sex, demographic data (income, education), body mass index, symptoms, duration of symptoms, treatment (surgery, chemotherapy, radiotherapy or combination) and survival outcome.  Analysis was performed using Kaplan-Meier models and log rank test.<br /><em><strong></strong></em></p><p><em><strong>Results</strong></em>: Fifty one patients were diagnosed with gastric adenocarcinoma during the study period, but follow-up data were available for 50. Median survival was 142 days. Age, sex, income, education, BMI, tumor location, and treatment modality were not significantly associated with overall survival. In Cox regression models, covariates associated with survival were a history of regular alcohol intake (HR 0.49, 95%CI 0.26,0.92; P=0.025) and intestinal type cancer histology (HR 0.40, 95%CI 0.19,0.83; P=0.01).<br /><em><strong></strong></em></p><p><em><strong>Conclusion</strong></em>: Prognosis of newly diagnosed gastric cancer in Zambia is poor with significant mortality within 1 year<br />of diagnosis, particularly among patients with weight loss and dysphagia.</p>key: titleInvalid data type in setData: Gastric Malignancy Survival in Zambia, Southern Africa: A two year follow up studykey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Asombangkey: givenNameInvalid data type in setData: AWkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Kayambakey: givenNameInvalid data type in setData: Vkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Turner-Mosskey: givenNameInvalid data type in setData: Ekey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Bandakey: givenNameInvalid data type in setData: Lkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Colditzkey: givenNameInvalid data type in setData: Gkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Mudendakey: givenNameInvalid data type in setData: Vkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Zulukey: givenNameInvalid data type in setData: Rkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Sinkalakey: givenNameInvalid data type in setData: Ekey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Kellykey: givenNameInvalid data type in setData: Pkey: submissionLanguageInvalid data type in setData: enkey: abstractInvalid data type in setData: <p><em><strong>Background</strong></em>: Heart failure is a major public health problem and has been recognized as an important cause of morbidity and mortality for several years. It is one of the leading non-infectious causes of death among hospitalized patients at the University Teaching Hospital (UTH) in Lusaka, Zambia. This study aimed to investigate the predictors of 30-day mortality in heart failure patients admitted to the medical wards at the UTH using routinely obtained clinical data.</p><p><em><strong>Methods</strong></em>: We enrolled 390 heart failure patients and followed them up over a period of 30 days. Data collected included demographic characteristics (age, sex), medication use and co-morbidities (hypertension, diabetes  mellitus, Human Immunodeficiency Virus (HIV) infection). Clinical data included vital signs, blood urea, serum sodium, serum potassium, serum creatinine, and haemoglobin level. Trans-thoracic echocardiographs and electrocardiographs were also done to determine left ventricular ejection fraction (LVEF) and to check for the presence of arrhythmias. Patients were dichotomized into those with preserved (LVEF&gt;=40 percent) and reduced (LVEF&lt; 40 percent) systolic function. Recruited patients were then prospectively followed up to determine outcome by day 30 (i.e. dead or alive). Cox proportion Hazard regression analysis (on Epi Info software version 3.5.3) was used to analyse the effect of each of these parameters on outcome.</p><p><strong><em>Results</em></strong>: Of the recruited patients, 59% were female (95% CI 54-64). The median age was 50 years (IQR 33-68). 138 patients (35%, 95% CI 31-40) died within 30 days of admission. 94 (68%) of these deaths occurred  in-hospital. The factors shown to be independent predictors of death onmultivariate logistic regression analysis were LVEF&lt;40 percent (OR=2.86, 95%CI 1.68- 4.87), NYHA class IV (OR=2.15, 95%CI 1.27- 3.64),serum urea above 15mmol/L (OR=2.48, 95%CI 1.07-5.70), and haemoglobin level below 12g/dL (OR=1.79, 95%CI 1.11- 2.89).The additional factor associated with increased risk of mortality on univariate analysis wassystolic blood pressure below 115mmHg (OR=1.63, 95%CI 1.05- 2.51). However, serum creatinine (OR=1.49, 95%CI  0.49-4.48) and HIV  seropositivity (OR=0.96, 95% CI 0.53-1.72)had no bearing on the risk of death in this patient population.</p><p><em><strong>Conclusions</strong></em>: Left ventricular ejection fraction &lt;40 percent, New York Heart Association class IV, serum urea above 15mmol/L, haemoglobin level below 12g/dLand systolic blood pressure below 115mmHg are predictors of poor 30-day outcome in hospitalised heart failure patients.</p>key: titleInvalid data type in setData: Factors associated with Mortality in Adults admitted with Heart Failure at the University Teaching Hospital in Lusaka, Zambiakey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Chansakey: givenNameInvalid data type in setData: Pkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Lakhikey: givenNameInvalid data type in setData: Skey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Andrewskey: givenNameInvalid data type in setData: Bkey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Kalinchenkokey: givenNameInvalid data type in setData: Skey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Sakrkey: givenNameInvalid data type in setData: Rkey: submissionLanguageInvalid data type in setData: enkey: abstractInvalid data type in setData: No Abstract.key: titleInvalid data type in setData: Heart failure in Zambia: Evidence for Improving Clinical Practicekey: affiliationInvalid data type in setData: key: biographyInvalid data type in setData: key: familyNameInvalid data type in setData: Gomakey: givenNameInvalid data type in setData: FMkey: submissionLanguageInvalid data type in setData: enkey: abbrevInvalid data type in setData: ARTkey: policyInvalid data type in setData: key: titleInvalid data type in setData: Articleskey: descriptionInvalid data type in setData: key: titleInvalid data type in setData: key: descriptionInvalid data type in setData: key: titleInvalid data type in setData: 
	
  

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		Vol. 41 No. 1 (2014)
							| Medical Journal of Zambia
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				  Heart failure in Zambia: Evidence for Improving Clinical Practice
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				  Factors associated with Mortality in Adults admitted with Heart Failure at the University Teaching Hospital in Lusaka, Zambia
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