Ultrasound Scanning Competencies in Midwifery Education in Zambia: Findings from a Desk Review and Needs Assessment

Introduction: Ultrasound is an essential component of antenatal care. Midwives provide most of the antenatal care but they do not perform ultrasound as it has been beyond their scope of practice. This leaves many women in Low and Middle-Income Countries without access to ultrasound scanning. The aim of this study was to identify competencies in ultrasound scanning in midwifery education. Methods: A desk review and needs assessment were conducted between July and October 2023. Articles and curricula on the internet, Google scholar and PubMed were searched for content on ultrasound scanning competencies. A Google form consisting of 20 questions was administered via email and WhatsApp to 135 participants. Descriptive statistics were used to analyse data. Results: The desk review showed that it is feasible to train midwives in ultrasound scanning. The training programs for midwives in obstetric ultrasound were conducted for 1 week to 3 months with most of them running for 4 weeks. Content included introduction to general principles of ultrasound, physics, basic knowledge in embryology, obstetrics, anatomy, measuring foetal biometry, estimating amniotic fluid and gestational age. Experts like sonographers trained midwives. Theory and hands on were the teaching methods used. Written and practical assessments were conducted. Needs assessment revealed that majority of participants 71 (53%) knew about basic ultrasound training for midwives. All participants (100%) said it is necessary to train midwives in basic ultrasound scan in Zambia. Some content should include, anatomy, measuring foetal biometry, assessing amniotic fluid level, and gestational age determination. Most participants 91 (67%) suggested that the appropriate duration of training is 4 - 6 weeks. Conclusion: Empowering every midwife with ultrasound scanning skills will enable early detection of any abnormality among pregnant women and prompt intervention to save lives.

Experiences of Mothers on the Utilization of Elimination of Mother to Child Transmission of HIV Services at Mtendere Clinic, Lusaka

Introduction: Acquired immunodeficiency syndrome is one of the leading causes of mortality among women of reproductive age and Mother to Child Transmission of Human immunodeficiency virus is still a challenge affecting many countries. Globally, an estimation of 180,000 children under 15 years acquire the Human immunodeficiency virus every day, and more than 90% of those infections are due to Mother to Child Transmission. The study sought to explore the experiences of mothers on the Elimination of Mother to Child Transmission-HIV services at Mtendere Clinic, Lusaka. Materials and Methods: Qualitative interpretive phenomenology study design was employed using in-depth interviews to collect data from a sample that was selected using purposive sampling technique. Thirteen participants were recruited, and these were HIV-positive mothers at least between the ages of 15 and 49 years and enrolled in the Elimination of Mother To Child Transmission-HIV program. The in-depth interviews were audiotape recorded and transcribed verbatim. Data was analyzed using thematic method. Findings: Three main themes that emerged are;living with HIV, support system and barriers to utilization of Elimination of Mother To Child Transmission-HIV services. Most of the participants expressed having acquired knowledge from the program, and received counselling and support from spouses, family as well as health personnel at Mtendere health facility which culminated into a positive experience and enhanced their uptake of the Elimination of Mother to Child Transmission-HIV services. However, barriers to service utilization were identified and these included fear of stigma, negative attitudes from health workers, long waiting times, lack of support and lack of transport to the health facility. Conclusion: Interventions such as community awareness campaigns on Elimination of Mother To Child Transmission-HIV, male involvement and implementing mother-to-mother peer support strategies in Elimination of Mother To Child Transmission-HIV service utilization should be prioritized so as to alleviate stigma and enhancing a positive experience for these mothers thus reducing on the Mother to Child HIV Transmission burden and mortality rates.

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.

Attitudes and Practices Contributing to Vaginal Stenosis in Women with Cervical Cancer Following Brachytherapy at Cancer Diseases Hospital in Lusaka, Zambia. A Cross Sectional Study

Background: Vaginal stenosis is an important adverse effect of brachytherapy for cervicalcancer. This study aimed to determine attitudes and practices contributing to vaginal stenosis following brachytherapy at the Cancer Diseases Hospital in Lusaka—Zambia. Methods: An analytical cross-sectional study design was employed, where 163 respondents were randomly selected after meeting inclusion criteria. A researcher-administered questionnaire was used to collect data and SPSS version 25 was used for data analysis. Results: Out of the 163 women enrolled in this study, 42.3% had developed vaginal stenosis while 57.7% did not with age range 15 - 60+ years. 76% exhibited good practices to measures against vaginal stenosis while majority (93.9%) of the respondents demonstrated poor attitudes towards measures to prevent the condition. Women with poor practices versus good practices (OR = 1.07, CI = 0.52 - 2.21, p = 0.855), poor attitudes versus good attitudes (aOR = 1.28, CI = 0.29 - 5.71, p = 0.746) and those employed versus unemployed (aOR = 1.76, CI = 0.73 - 4.27, p = 0.210) had increased odds of vaginal stenosis. However, these increasing effects were not significant at 5% level of significance. Although length of brachytherapy showed no significant effect independently, the odds of having vaginal stenosis were over 2 times higher for women who had been on brachytherapy between 6 and 12 months compared to those on brachytherapy for less than 6 months (OR = 2.45, CI = 1.03 - 5.82, p = 0.042). Conclusions: Failure to practice recommended measures and poor attitudes towards therapy contributes to vaginal stenosis. Efforts should be channeled towards overcoming religious, traditional, cultural and personal impediments contributing to vaginal stenosis in women with cervical cancer receiving brachytherapy.