Adverse Pregnancy Outcomes Following Cryotherapy, Thermal Ablation and Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia Treatment: A Pilot Study among Zambian Women

Background: Cervical Intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Majority of the recipients of these treatments are women within the reproductive age group, who according to literature may be at risk of adverse pregnancy outcomes. This pilot study is part of a study investigating adverse pregnancy outcomes among women who received Cryotherapy, Thermal ablation and Loop Electrosurgical Excision Procedure compared to the untreated women in Zambia. Materials and Methods: This descriptive study analyzed records of 886 (n = 443 treated and n = 443 untreated) women aged 15 - 49 years. The women were either screened with Visual Inspection with Acetic Acid or treated for Cervical Intraepithelial neoplasia at the Adult Infectious Disease Centre between January 2010 and December 2020. Women meeting the criteria were identified using the Visual Inspection with Acetic Acid screening records and telephone interviews to obtain the adverse pregnancy outcome experienced. Data were analysed using STATA version 16 to determine the prevalence and obtain frequency distribution of outcomes of interest. Univariate and multivariable binary logistic regression estimated odds of adverse pregnancy outcomes across the three treatments. Results: The respondents were aged 15 to 49 years. Adverse pregnancy outcomes were observed to be more prevalent in the treatment group (18.5%) compared to the untreated group (5.4%). Normal pregnancy outcomes were lower in the treated (46.3%;n = 443) than the untreated (53.7%;n = 443). The treated group accounted for the majority of abortions (85.2%), prolonged labour (85.7%) and low birth weight (80%), whereas, the untreated accounted for the majority of still births (72.7%). Women treated with cryotherapy (aOR = 2.43, 95% CI = 1.32 - 4.49, p = 0.004), thermal ablation (aOR = 6.37, 95% CI = 0.99 - 41.2, p = 0.052) and Loop Electrosurgical Excision Procedure (aOR = 9.67, 95% CI = 2.17 - 43.1, p = 0.003) had two-, six- and ten-times higher odds of adverse pregnancy outcomes respectively, relative to women who required no treatment. Conclusion: Adverse pregnancy outcomes are prevalent among women who have received treatment in Zambia. The findings indicate that treating Cervical Intraepithelial Neoplasia has been linked to higher chances of experiencing abortion, delivering low birth weight babies and enduring prolonged labor that may result in a caesarean section delivery. Cervical neoplasia treatments, particularly Loop Electrosurgical Excision Procedure, are associated with significantly increased odds of adverse pregnancy outcomes. It is essential to include information about prior Cervical Intraepithelial neoplasia treatment outcomes in obstetric care.

Assessing Malnutrition in Pregnant Women Using the Dietary Diversity Score and the Mid-Upper Arm Circumference: A Cross-Sectional Study, Zambia

The dietary diversity score (DDS) and the mid-upper arm circumference (MUAC) can be used to assess nutritional status. The DDS is a qualitative measure of food consumption reflecting an individual’s access to different food items and therefore a proxy indicator of the nutritional status. The aim of the study was to assess whether the dietary diversity score and MUAC can be used to assess the nutritional status of pregnant women attending antenatal. A cross-sectional survey was conducted at Chilenje level I Hospital in a township located in Lusaka city, Lusaka province. The study employed quantitative methods to collect and analyse data on the dietary patterns of individuals in the previous 24 hours before the survey. Health facilities were randomly selected and systematic sampling was used to select a sample of 299 pregnant women. An interview schedule was used to collect data. Median and interquartile range were used to compare demographic data. Spearman’s Correlation for two continuous variables was used to establish associations between DDS and the MUAC. The median age was 27 years. About 44% of the women were in the lowest dietary diversity category, indicating inadequate nutrient intake, 31% in the medium category and 24% in the high intake. Dietary diversity score was negatively correlated with mid-upper arm circumference (p = 0.1295). However, most of the women in the lower dietary diversity score category (75%) had a high mid-upper arm circumference meaning that their nutritional status was good. Dietary diversity score can be used to predict malnutrition in pregnant women. The mid-upper arm circumference was negatively correlated with the 24hour dietary diversity score implying that we might not rely on this measurement to assess the nutritional status.

Midwifery Students’ Confidence in New-Born Care at Completion of Training in Selected Midwifery Schools in Zambia. A Multicentric Study: A Case of Zambia

Background: Quality education is one of the important factors in empowering midwives to provide quality health care services to mothers and newborns irrespective of their practice settings. Due to lack of standardization of the duration, content, and structure of midwifery education and different pathways to midwifery across the world, midwives may lack the confidence to deliver quality health care services in the main domain of the ICM competences. Aim: To assess the confidence of final year midwifery students in the domain of new-born care based on the ICM midwifery competencies. Methods: The first phase consisted of a quick situation analysis of midwifery education and regulation in Zambia, followed by a cross-sectional survey through a self-administered questionnaire to assess the confidence of final year midwifery students. Results: Most (51.9%) of the respondents were aged between 18 and 28 years, and majority of them were placed in Levels 1, 2 and 3 Hospitals and also clinics for their clinical practice, with between one hundred to ten thousand annual births, followed by 16.9% who were placed in Level 3 hospitals only. Most students (38.3%) reported receiving classroom instruction by both Lecture and Demonstration. Few students (22.7%) responded that they were not satisfied with their clinical supervision, while 77.3% were satisfied. There was significant association between confidence to perform skills independently and having enough time to practice on models in the labs (p value = 0.024), confidence when practiced for the first time on mothers (p value = 0.007) and satisfaction with supervision during clinical practice (p value = 0.000). Binary logistic regression of characteristics associated with confidence to perform new-born skills independently revealed significant association between satisfaction with clinical supervision and confidence to perform skills independently, 95% CI [1.83, 15.37]. Conclusion: Midwifery students need quality training both theoretically and practically in order for them to gain confidence in newborn care upon completion of their training. They need adequate time to practice on models in the skills laboratory, and need adequate clinical supervision for them to gain confidence in performing new born skills independently.

Perception of the Community towards Child Sexual Abuse: A Case of Chawama Lusaka, Zambia

A number of scholars have reported high incidence of sexual abuse cases among children in the communities. However, little is known about the perceptions the community people have towards child sexual abuse cases. Therefore, this study aimed to explore the perception of the community towards child sexual abuse which hinders the disclosure and reporting of abuse cases. Data were collected through focused group discussions and indepth interviews, with sixty nine participants from nine (9) focused group discussions and nine (9) indepth interviews. Participants were the general community members and relatives to abused children. The interviews were recorded verbatim and transcribed;analysis of data was done using qualitative thematic analysis. Three themes emerged summarizing the factors associated with non-reporting of child sexual abuse cases which included, fear of family and community breakdown, relationship between the victim and the perpetrator and inadequate service provision by the police which also reflected the community’s role in supporting the child. In conclusion the study therefore showed that child sexual abuse is common in Zambia and cases are still on the increase. However, there is great need to enforce laws regarding sexual abuse and in addition great change in attitude is needed to prevent occurrence of cases.

Community Attitudes towards Child Sexual Abuse: A Case of Chawama Lusaka, Zambia

Background: Child sexual abuse continues to be an issue of great concern and recognized as a public health problem in Zambia. Hence the study examined community attitudes and beliefs that shape communities perceptions towards child sexual abuse, the interaction between adults and children which consequently hinder reporting of child sexual abuse cases. Methods: A qualitative study design was employed. Nine focus group discussions (FGD) with 49 participants comprising 5 to 6 participants in each FGD and nine indepth interviews guided by an interview guide were used to collect data. Participants were selected using purposive sampling. The collected data were transcribed verbatim and analyzed using thematic analysis. Results: Two major themes namely: 1) Defilement, an unacceptable yet concealed phenomenon, and 2) Parental negligence as a major contributor to child sexual abuse, emerged from the data. Participants highlighted that communities regarded child abuse to be necessary for reported only if the abused child was less than 5 years old, a female, and if the trauma the child was subjected to was severe. This was because older girls were seen to be able to have consensual sex, and boys were traditionally viewed as being strong and thus, not report most cases. Parents were also seen to be losing control over their children as most of them were involved in excessive alcohol intake, leading to failure in managing their children. Poverty was another aspect reported to have led parents to send their children into prostitution. As a result parents could not report, as they felt they partly contributed to their children being sexually abused. Conclusion/Recommendations: The study showed that communities do not accept child sexual abuse, but yet they were reluctant to report the cases. It is imperative therefore, that communities learn the importance of reporting sexual abuse cases;as failure to report is risky behavior that can put the abused child and others at risk of other negative vices too.