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.

Adherence to Radiation Therapy among Cervical Cancer Patients at Cancer Diseases Hospital in Lusaka, Zambia

Background: Radiation therapy has the potential to improve cure rates and provide palliative relief for cervical cancer patients. Despite adherence to radiation therapy being a key treatment modality, patients rarely follow prescriptions. Poor adherence to radiation therapy is associated with low survival and high mortality rates. This study therefore sought to investigate the levels of adherence and factors influencing adherence to radiation therapy among cervical cancer patients being treated at Cancer Diseases Hospital. Methods: A cross-sectional analytical study design was used, 142 patients were selected from the outpatient department using a fishbowl sampling method. A structured interview schedule was used to collect data. Data was entered and analyzed using SPSS, the binary logistic regression analysis was used to predict levels of adherence to treatment and to identify factors associated with adherence to RT among cervical cancer patients. Results: The findings showed that 93% of the participants adhered to radiation therapy while 7% did not adhere to treatment. Majority of the patients 77.1% had experienced side effects of radiation therapy. About 28% of patients had severe psychological distress. By using binary logistic regression, there was a statistically significant association between adherence and perceived quality of health care services (p = 0.001). The analysis showed that patients who perceived poor quality of health care services were 0.005 (99.5%) times less likely to adhere to radiation therapy. The other independent variables were not statistically significant despite being associated with adherence among cervical cancer patients. Conclusions and Recommendations: The findings showed that patients who perceived good quality of health care services had higher chances of adherence compared to those who perceived poor quality of health care services. There is therefore a need for quality service provision which could include good maintenance of radiation machines. Furthermore, there is a need to develop guidelines for follow-up in case of any disease outbreak to avoid interference with patients’ treatment schedules and appointments for reviews.

Quality of Intrapartum Care: Direct Observations in Selected Health Facilities in Zambia

Approximately 303,000 women die annually while giving birth, worldwide, and more than 99% of the deaths occur in developing countries. In Zambia, a developing country situated in sub-Saharan Africa, most of the maternal mortalities occur during the intrapartum and immediate postpartum periods, arising from postpartum hemorrhage, sepsis, obstructed labor, and hypertensive disorders. Aim: The aim of this study was to assess the quality of intrapartum services provided in health facilities in the country. Methodology: Guided by a descriptive cross sectional design, data were collected from 264 women in labor using a World Health Organization validated observation checklist. Convenience sampling was used to recruit the women, while multistage sampling was used to select four health facilities. The Social Package for Social Sciences, version 23 was used to analyze the data. Results: One health facility met the World Health Organization 80% minimum standard in four out of the five categories used to measure quality in intrapartum care, while the other three met the minimum standard in one category each. Conclusion: Low numbers of midwives, inadequate supplies and equipment were major obstacles to following national and international agreed standards for providing optimal care during intrapartum period. Recommendations: There is need for local and national stakeholders in Zambia to urgently address the structural barriers that were observed, as well as invest in sufficient numbers of adequately trained and motivated midwives.

Study Protocol on Stroke Management: Role of Nurses and Physiotherapists at the Adult University Teaching Hospital, Lusaka Zambia

Background: Management of stroke patients requires a multidisciplinary approach. Literature presents unequivocal evidence of improved outcomes when patients are treated in a stroke unit by multi-disciplinary teams made up of medical doctors, nurses, physiotherapists and occupational therapists. Among the multidisciplinary team members, physiotherapists and nurses are the largest professional workforce working with both stroke patients and survivors. This study, therefore, aims at investigating the role of nurses and physiotherapists in the management of stroke patients at the Adult University Teaching Hospital. Methodology: This study shall utilize a convergent parallel mixed method design where both quantitative and qualitative data will be collected at the same time resulting in two data sets which will eventually be merged at the point of discussion. The quantitative component shall utilize an analytical cross-sectional approach while the qualitative component shall use a qualitative case study approach. The study will be conducted at the Adult University Teaching Hospital in Lusaka. Data will be collected from all the 287 nurses and 37 physiotherapists working in the Emergency Department, Medical Wards, Adult Intensive Care Unit and the Department of Physiotherapy. Quantitative data will be analyzed using Statistical Package for social sciences. Descriptive statistics shall be computed on the role of nurses and physiotherapists in stroke care. In addition, chi-square and fisher’s exact tests will be used in the test for associations between variables while binary logistic regression will be used in identifying predictors of the various roles played by nurses and physiotherapists in the management of stroke patients. Qualitative data will be analyzed using thematic analysis in order to generate new concepts and a substantive model of care for stroke patients. Conclusion: Despite research evidence of improved outcomes when stroke patients are managed by a multi-disciplinary team, data on the role of different members of the multidisciplinary care team in stroke management is almost non-existent from the Zambia context. It is therefore hoped that information obtained from this study will be used as a basis for recommending the streamlined role of the nurse and physiotherapist in both acute care and rehabilitation.

Adverse Pregnancy Outcomes Following Cryotherapy, Thermal Ablation, and Loop Electrosurgical Excision Procedure for Cervical Treatments among Reproductive Age Women in Zambia

Background: Cervical Intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Most recipients are women of reproductive age who, as reported in the literature, may be at risk of adverse pregnancy outcomes. This study investigated the risk of abortions, prematurity, stillbirths, and prolonged labor among reproductive-age women following Cryotherapy, Thermal ablation, and Loop Electrosurgical Excision Procedure treatments in Zambia. Methods: This cross-sectional study analyzed records of 8000 women aged 15 - 49 years at the Adult Infectious Disease Control Centre using records between January 2010 and December 2020. Women constituting the treatment group were all respondents treated by cryotherapy, thermal ablation, and LEEP, while the control group were VIA negative women. Women from both groups were invited to answer a phone survey. Data were analyzed using Stata version 16;descriptive analysis estimated the prevalence and obtained the frequency distribution of abortion, prematurity, prolonged labor and fresh stillbiths. Chi-square and Fisher’s exact test established the associations of CIN and APOs at 95% Confidence intervals. Univariate and multivariable binary logistic regression estimated the odds of adverse pregnancy outcomes across the three treatments. Results: Adverse pregnancy outcomes were more prevalent in the treatment group (39.2%) compared to the untreated group (16.9%). Across the two groups, normal outcomes were lower in the treated (42.3% vs 57.7%). The treated group accounted for the majority of abortions (74.5% vs 25.5%) and prolonged labor (72.5% vs 27.5%), while the untreated group accounted for higher proportions of stillbirths (66.7% vs 33.3%) and prematurity (53% vs 47%). Adverse pregnancy outcomes were five and two times more likely in women treated with thermal ablation (aOR = 5.05, 95% CI = 4.01 - 6.36, p Conclusion: Cervical treatment among Zambian women increases the risk of abortion and prolongs labor. Therefore, caution should be taken when administered to those of reproductive age. Vigilant monitoring should be maintained during pregnancy, delivery, and postpartum to improve maternal and neonatal health.