Lusaka Apex Medical University

Abstract Background Hypertension is a growing contributor to morbidity and mortality in sub-Saharan Africa, yet many adults are still unaware of how to prevent it. In Zambia, preventive behaviours such as regular exercise, reduced salt intake, and routine blood pressure checks are underutilised. This study examined the factors associated with hypertension prevention practices among adults in Mtendere Compound, a high-density residential area in the capital-city of Zambia Lusaka. Methods A cross-sectional study was conducted among 382 adults aged 18 to 65 years, selected through multistage random sampling. Data were collected using structured interviewer-administered questionnaires adapted from the WHO-STEPS tools. Key variables included demographic characteristics, knowledge of hypertension, health-seeking behaviour, and lifestyle factors. Descriptive statistics and logistic regression were used to analyse associations between independent variables and hypertension prevention practices as a compound outcome variable including low salt intake, regular exercises and check-ups. Results Among participants, 58.6% showed adequate knowledge of hypertension prevention. However, only 41.1% reported practising at least three recommended behaviours. Receiving health advice at a facility (AOR: 3.09, 95% CI: 1.72-5.56), having good knowledge (AOR: 2.64, 95% CI: 1.46-4.75), and being employed (AOR: 1.78, 95% CI: 1.02-3.09) were independently associated with practicing preventive behaviours. Age, sex, and education level were not statistically significant predictors. Conclusion While majority of the respondents had adequate knowledge of hypertension prevention, the actual practice was low. This study underscores the community-based reinforcement of social behavioural change (SBC) to transform knowledge into practice among at risk populations. Specifically, the study recommends tailoring interventions on hypertension prevention to reach unemployed and under-informed populations informal settlements and other high-density settings in major towns and cities in sub-Saharan Africa.

Klebsiella pneumoniae is a leading cause of neonatal sepsis in low- and middle-income countries, with antimicrobial resistance (AMR) significantly contributing to mortality. We used whole genome sequencing to explore the impact of an infection prevention and control (IPC) intervention on K. pneumoniae strains and transmission dynamics responsible for sepsis in a Zambian neonatal unit. Blood culture isolates were collected during the Sepsis Prevention in Neonates in Zambia (SPINZ) study, including a 7-month baseline period and 12 months following implementation of a low-cost IPC bundle. K. pneumoniae genomes associated with 411 neonatal infections were characterised, comprising 24 unique sequence types (STs) and dominated by ST307 (69.3%, n = 285). Nearly all isolates (99.0%) carried extended spectrum beta-lactamases, but few carried carbapenemases (2.7%). Most infections (95.6%) were associated with probable transmission clusters, ranging in size from 2-202 patients and spanning durations of 2-232 days. Most K. pneumoniae (n = 228, 70%) were isolated during the 7-month baseline period and formed six clusters, including one cluster of >200 neonates infected with ST307. Transmission of all strains was periodically suppressed by an IPC bundle; however not all strains were eliminated, and some were able to re-emerge later to re-establish infection and transmission, alongside newly introduced strains that formed additional transmission clusters. Some clusters were associated with rapid onset of disease (within 2 days of admission) and others with delayed onset, suggesting different sources of contamination (e.g., reagent vs environmental). These findings reinforce the need for sustained IPC efforts, and better understanding of environmental reservoirs of opportunistic pathogens in neonatal units to inform such efforts.

Background Carbapenem and third-generation cephalosporin (3GC) resistance among Enterobacterales poses a serious threat to human and animal health. This study aimed to identify and characterize carbapenem- and 3GC-resistant Enterobacterales isolated from poultry in Lusaka Province, Zambia. Methods Ninety pooled cloacal samples were collected from market-ready broiler chickens in Chongwe and Chilanga districtsof Lusaka Province. The isolates were screened for 3GC and carbapenem resistance using disk diffusion and broth microdilution. PCR and Sanger sequencing were performed for species identification and detection of the β-lactamase-encoding (bla) genes, including blaCTX-M, blaTEM, blaOXA-1, and blaSHV. Hierarchical clustering was used to assess phenotypic and genotypic relationships. Results A total of 83 3GC-resistant Gram-negative isolates were recovered, of which 12% were also carbapenem-resistant. Escherichia coli was the most prevalent species, followed by Klebsiella pneumoniae and Enterobacter spp., then Pseudomonas aeruginosa, other Pseudomonas spp., Acinetobacter baumannii, Citrobacter freundii, and Aeromonas caviae. Multidrug resistance (MDR) occurred in 84.3% of the isolates, with the highest resistance to ampicillin, tetracycline, and co-trimoxazole. Overall, 80.7% of the isolates harbored at least one of the four tested bla genes, with blaCTX-M and blaTEM being the most common. Hierarchical clustering revealed that isolates from both districts shared similar phenotypic and genotypic resistance patterns. Conclusions The presence of multidrug- and carbapenem-resistant Enterobacterales from poultry highlights the emergence of carbapenem resistance in Zambia’s food production sector. Imipenem-resistant isolates indicate the potential for transmission of resistance genes between animals and humans. These findings underscore the need for prudent antimicrobial use, strengthened stewardship, and One Health surveillance to contain the spread of carbapenem resistance genes.

The Kochi Declaration 2024 (resulting from the International Leadership Summit of Medical Associations) marks a significant step in global TB elimination efforts. By emphasising private sector engagement, it addresses critical gaps in TB care delivery, particularly in high-burden countries where 60%–80% of patients initially seek care from private providers. This initiative aligns with the WHO’s public–private mix approach, enhancing case detection, treatment quality, and global health equity. It underscores the potential of collaborative strategies to accelerate progress towards a TB-free world by 2030, aligning with United Nations High-Level Meeting targets and broader global health goals.

Problem-Based Learning (PBL) has emerged as a promising strategy for teaching Evidence-Based Practice (EBP) to nursing and midwifery professionals. However, its effectiveness remains insufficiently synthesized, with few studies directly addressing its impact on EBP competencies. To systematically review and synthesize evidence on the efficacy of Problem-Based Learning as a teaching approach for developing Evidence-Based Practice competencies among nursing and midwifery students and professionals. This systematic review with narrative synthesis was conducted in accordance with the Cochrane Handbook and reported following PRISMA 2020 guidelines. The protocol was registered in PROSPERO (CRD42023390989). A comprehensive search of MEDLINE, CINAHL, PubMed, EMBASE, Web of Science, ERIC, PsycINFO, and Cochrane CENTRAL was performed from inception through August 2025. Two reviewers independently screened and appraised studies using JBI-SUMARI tools and ROBINS-I. Eighteen studies met inclusion criteria, but only three (16.7%) specifically examined PBL for EBP education among nursing students in Iran, Japan, and South Korea. These consistently demonstrated significant improvements in knowledge, attitudes, critical thinking, and clinical decision-making compared with traditional methods, with all rated at low risk of bias. Broader EBP education studies reported highly variable implementation rates (13–100%), with higher educational levels linked to greater uptake of evidence-based behaviours. Across studies, factors supporting success included adequate time, access to technological resources, faculty preparation, and organizational support. Common barriers were limited infrastructure, faculty workload, and students’ initial resistance to active learning. Preliminary evidence suggests PBL enhances EBP-related competencies, but the current evidence base is small, heterogeneous, and lacks midwifery-specific studies. Rigorous comparative research using standardized outcomes and evaluating long-term practice impact is needed to establish optimal strategies for integrating PBL into nursing and midwifery education.

Background/Objectives: Antimicrobial resistance (AMR) is a critical global health threat, with sub-Saharan Africa disproportionately affected. Antimicrobial stewardship (AMS) programs are essential in combating AMR; however, data on their implementation in resource-limited settings like Zambia remain scarce. This study assessed the post-implementation status of World Health Organization (WHO) AMS core elements in selected public hospitals in Zambia. Methods: A cross-sectional pre- and post-intervention survey was conducted in 11 public hospitals across Zambia’s 10 provinces. Baseline (pre-implementation) and 12-month follow-up (post-implementation) assessments were carried out using the WHO-adapted Periodic National and Healthcare Facility Assessment Tool. The six AMS core elements evaluated included leadership, accountability, AMS actions, education, monitoring, and feedback. Results: The average AMS program score increased from 59% at pre-implementation to 81% at post-implementation. Significant improvements were observed in education and training (+36%) and accountability (+31%). While leadership and monitoring also showed positive trends, gaps persisted in AMS actions (63%) and feedback/reporting mechanisms (68%). Drug and Therapeutics Committee (DTC) functionality improved by 23%, with 90% of facilities now holding regular DTC meetings. Implementation of AMS actions, such as ward rounds, rose from 0% to 73%. Challenges remained in clinical audit feedback, resource mobilization, and prescribing optimization. Variability across facilities highlighted differences in leadership, resources, and technical capacity. Conclusions: AMS implementation in Zambia improved substantially across key domains. However, sustained leadership, adequate financing, and continuous capacity-building are needed to address persistent gaps and ensure long-term success in mitigating AMR.

Background: Stroke survivors experience functional disability that negatively affects their quality of life. Quality of life refers to people’s perceptions of the culture and value systems where they live, and this includes their goals, expectations, standards and concerns. It is multi-factorial, comprising physical, functional, psychological, emotional, social and environmental domains. Higher QoL is associated with independent daily living, higher education, better socio-economic status and better social support, whereas lower QoL is associated with anxiety, depression and fatigue, and greater functional dependence. Objective: To assess the quality of life in post-stroke patients who are following a 12-week strength training program, 4 months post intervention. Methodology: This study was a comparative single-blinded randomized, controlled trial (RCT) using a parallel design. The sample size was 66 stroke survivors from out-patient physiotherapy departments at three Level I hospitals (Chawama, Kanyama and Matero) located in Lusaka Province. Stroke survivors aged 20-65 years and above, right- or left-sided limb hemiparesis, male and females, with stroke duration of 24 hours to 6 months were included in this study. The ICF core scores were summarised using frequencies and percentages, presented as tables. The Barthel Index Scale’s descriptive statistics such as frequencies and percentages were used to summaries all the eight (8) elements. The SIS tool was summarised into eight (8) domains with a set of questions sitting on a 5-point Likert Scale. The Chi-Square Test and Fishers Exact Test (based on the assumptions of each test) were used to compare quality of life using the BI and ICF between the control group to those in the experimental group. The STATA package was used for descriptive statistics such as frequencies and percentages to summarise the categorical variables of this study. The Chi-Square Test and Fishers’ Exact Tests (Based on the assumptions of each) were used to compare differences in the distribution of characteristics by the study arms (Experimental vs Control group). The 95% confidence interval was taken as the precision of the effect estimate study. Results: QoL for ICF at endline was statistically significant for improved sleeping patterns (p<0.020), pelvic movements (p<0.016), and the ability to dress oneself (p<0.048). QoL for SIS and BI at endline was statistically significant for improved mobility at p<0.026 and p<0.031 respectively. In comparison to the baseline, BI score had a p-value <0.024 at endline with GMT and GSD 15.6 (1.3) in the experimental group. Conclusion: This study concluded that the quality of life of stroke patients greatly improves following 12 weeks of strength training and in particular functional ability, physical and psychological status and the social aspect. Keywords: Quality of life, Health-related quality of life, Strength training, Stroke patient, Stroke

In Zambia, 40% of clinical Gram-negative bacteria are either Escherichia coli or Klebsiella pneumoniae, with a high third-generation cephalosporin (3GC) resistance prevalence. Therefore, 3GC resistance surveillance is a crucial indicator for guiding focused intervention policies. However, the lack of genotypic diagnostic tools limits the ability to elucidate trends, especially in peri-urban and rural areas of developing countries. This study aimed to develop a rapid, cost-effective tool for the genotypic surveillance of 3GC resistance. Here, 900 stool samples collected from patients in Kafue (peri-urban, n = 400) and Katete (rural, n = 500) districts of Zambia were used for bacterial isolation on MacConkey agar supplemented with 1 μg/ml cefotaxime. Isolated 3GC-resistant strains were characterized by sequencing the 16S rRNA gene and screening for blaCTX-M and blaTEM genes using single polymerase chain reaction (PCR). Furthermore, selected 3GC-resistant strains were subjected to whole-genome sequencing (WGS) using MiSeq/HiSeq (n = 34) and MinION (n = 1). Using the data from this and other previous studies, we developed a rapid PCR-dipstick DNA chromatography-based tool for detecting blaCTX-M, blaTEM, E. coli-specific yaiO, and K. pneumoniae-specific khe genes. The prevalence of isolated 3GC resistant strains was 15.4% (139/900), dominated by E. coli (102/139, 73.4%). On PCR, the blaCTX-M gene was detected in 72.7% (101/139) of the isolates, while blaTEM was found in 46.8% (65/139) of the strains. The developed tool displayed a high level of agreement with WGS and single PCR/Sanger sequencing, with sensitivity and specificity ≥ 95% and Kappa ≥ 0.95 for each of the four target genes. We envisage that the simplicity and adaptability of this tool will be a significant advantage for the surveillance of 3GC resistance in Zambia and elsewhere.

Male involvement in maternal and child health (MCH) is a vital pathway for addressing gender disparities in maternal and newborn care. However, in many African low- and middle-income countries, including Zambia, male participation remains a significant challenge. This study explored the factors influencing male involvement in MCH in Mwandi District using a qualitative case study design. Data was collected through in-depth interviews and focus group discussions with frontline healthcare workers and community members and analyzed using inductive thematic analysis in Nvivo software. Findings revealed that economic constraints, traditional gender roles, cultural beliefs, and limited knowledge about maternal health significantly hinder male involvement. Men often prioritize breadwinning responsibilities, while cultural norms perceive MCH as a woman's duty. Nonetheless, younger men demonstrated a more progressive attitude toward shared responsibilities in parenting and maternal health. The study concludes that despite low male participation due to these barriers, community-based programs and government initiatives are making gradual progress in fostering male involvement. Evidence-based recommendations were provided to address the barriers and enhance male participation, ultimately improving health outcomes for women and children