Mulungushi University

Anaemia remains a major comorbidity among children living with HIV (CLHIV) in sub-Saharan Africa, yet sex-specific risk factors are poorly characterized. This study investigated the prevalence and sex-based determinants of anaemia among CLHIV in the Southern Province, Zambia. A retrospective cross-sectional study was conducted using medical records from 321 CLHIV aged 0–14 years. Data on demographic, clinical, and anthropometric variables were analysed. Sex-stratified multivariable logistic regression identified factors associated with anaemia (Hb < 10.9 g/dL). Overall anaemia prevalence was 47.0% (151/321), with a higher, though not statistically significant, burden in males (52.6%) than females (41.9%). Younger age was a strong, independent risk factor across both sexes. Distinct sex-specific determinants were identified. In males, no statistically significant association between CTX use and anaemia was observed (Adjusted Odds Ratio, AOR = 3.04; 95% CI: 0.95–9.74). Care provided by an aunt was significantly associated with lower odds of anaemia compared to other caregiving arrangement (AOR = 0.10; 95% CI: 0.01–0.90). Poor anthropometric indices (height and weight) were significantly associated with anaemia in both sexes. The study findings reveal a high prevalence of anaemia among CLHIV in Zambia, with nuanced sex-based differences in its determinants. The findings advocate for differentiated, gender-sensitive intervention strategies. For boys, careful review of CTX prophylaxis is warranted, while for girls, enhancing supportive caregiving environments may be protective. Integrating these sex-specific approaches into paediatric HIV programs is crucial for reducing the anaemia burden and improving clinical outcomes.

Education systems worldwide continue to face persistent challenges, including unequal access, inconsistent quality, and outdated curricula, which collectively hinder the attainment of optimal academic outcomes. Within this complex landscape, schools’ internal environments have become crucial factors in their success. This study quantitatively examined the complex relationships among school climate, school culture, and student achievement in Zambian secondary schools by comparing government- and grant-aided institutions. Grounded in the Social Identity Approach, this research aimed to identify the mechanisms by which a school's environment impacts its success. A self-administered questionnaire was distributed to 304 teachers from 12 secondary schools in the Kabwe District, Zambia. Structural equation modelling (SEM) was employed to analyse the data. Data were analysed using the Statistical Package for the Social Sciences (SPSS) and structural equation modelling (SEM) in Stata 18. Factor analysis and Confirmatory Factor Analysis (CFA) were conducted to assess factor loadings, examine relationships among school climate, school culture, and student academic success, and verify the reliability and validity of the constructs before SEM. The results revealed that the school climate had a significant positive influence on school culture, with a more pronounced effect in grant-aided schools. School culture also has a direct and positive impact on student achievement, particularly in grant-aided institutions. Furthermore, the school climate had a significant and direct influence on student achievement, with a greater effect in grant-aided schools. Notably, school culture significantly mediated the relationship between school climate and student achievement, with the mediating effect more substantial in grant-aided schools. These findings suggest that a favourable school climate not only directly enhances student success but also does so indirectly by nurturing a strong, positive school culture, which subsequently becomes a key driver of student achievement. This study offers practical implications for educational policymakers, school leaders, and teachers, providing a comprehensive plan for improvement initiatives that emphasise investing in school climate and culture to enhance student outcomes.

Abstract Depression is a common and clinically significant mental health condition among university students, particularly those experiencing academic failure and course repetition, and is associated with adverse effects on cognitive functioning, emotional regulation, and academic performance. This study evaluated the efficacy of an internet-based cognitive behavioural therapy (iCBT) intervention, MoodGYM, in reducing depressive symptoms among repeating undergraduate students at the University of Zambia Ridgeway Campus. A quasi-experimental quantitative study design was employed. Seventy-five repeating undergraduate students with depressive symptoms were enrolled, with 33 assigned to the MoodGYM intervention group and 42 to a control group. Depressive symptom severity was assessed using the Beck Depression Inventory (BDI) at baseline and after an eight-week intervention period. Statistical analyses included within-group and between-group comparisons, difference-in-differences estimation, and fixed-effects regression modelling. At baseline, participants exhibited predominantly moderate to severe depressive symptoms, with no statistically significant differences between the intervention and control groups. Following the eight-week intervention, the MoodGYM group demonstrated a statistically and clinically significant reduction in depressive symptoms, with median BDI scores decreasing from 22 to 16 (p &lt; 0.001), representing a large effect size (Cohen’s d = 1.02). In contrast, the control group showed persistence or worsening of depressive symptoms over the same period. Difference-in-differences analysis confirmed a robust intervention effect, with an approximately 10-point greater reduction in depression scores among MoodGYM participants compared with controls (p &lt; 0.001). These findings indicate that MoodGYM is an effective internet-based intervention for reducing depressive symptoms among repeating undergraduate students and offers a feasible and scalable approach to addressing student mental health needs in low-resource university settings.

This paper examines an optimal investment–consumption problem in a setting where the financial environment is influenced by both stochastic factors and delayed effects. The investor, endowed with Constant Relative Risk Aversion (CRRA) preferences, allocates wealth between a risk-free asset and a single risky asset. The short rate follows a Vasiˇček-type term structure model, while the risky asset price dynamics are driven by a delayed Heston specification whose variance process evolves according to a Cox–Ingersoll–Ross (CIR) diffusion. Delayed dependence in the wealth dynamics is incorporated through two auxiliary variables that summarize past wealth trajectories, enabling us to recast the naturally infinite-dimensional delay problem into a finite-dimensional Markovian framework. Using Bellman’s dynamic programming principle, we derive the associated Hamilton–Jacobi–Bellman (HJB) partial differential equation and demonstrate that it generalizes the classical Merton formulation to simultaneously accommodate delay, stochastic interest rates, stochastic volatility, and consumption. Under CRRA utility, we obtain closed-form expressions for the value function and the optimal feedback controls. Numerical illustrations highlight how delay and market parameters impact optimal portfolio allocation and consumption policies.

BackgroundPreeclampsia (PE) is a significant obstetric complication associated with adverse maternal and fetal outcomes. Zambia, like several Sub-Saharan African nations, experiences a high prevalence of pregnancy-related hypertension, with PE being a major contributor to maternal and foetal mortality. This study aimed to identify the factors associated with the development of PE.MethodsWe conducted a cross-sectional study at Livingstone University Teaching Hospital in Zambia (LUTH). PE was defined as new-onset hypertension with systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg occurring after 20 weeks of gestation, accompanied by proteinuria with dipstick reading of 1 + . Data from patients’ most recent hospital visits was collected by trained research assistants using medical record abstraction. A total of 1018 participants were included. Demographic, clinical, and haematological parameters were analysed. We conducted both descriptive and inferential analyses using Stata version 17. Univariable and multivariable logistic regression were employed to investigate factors associated with PE.ResultsThe median age of participants was 27 years (IQR: 21–33). The prevalence of PE was 12.2% (n = 124). Among the 17.7% (n = 172) of participants who were employed, 19.1% (n = 33) had PE. Factors positively associated with PE included increasing age (Adjusted Odds Ratio [AOR]: 1.07, 95% Confidence Interval [CI]: 1.02–1.12, p = 0.002), a previous history of PE (AOR: 30.8, 95% CI: 8.7–108.6, p < 0.001), and a family history of PE (AOR: 9.97, 95% CI: 2.53–39.27, p = 0.001). Conversely, a unit (week) increase in gestational age was negatively associated with PE (AOR: 0.89, 95% CI: 0.83–0.97, p = 0.007).ConclusionThis study identifies maternal age, family history, and prior obstetric history as key associated factors for PE, emphasizing the need for targeted screening and early intervention. Enhanced prenatal care, including routine risk assessments, patient education, and regular monitoring through blood pressure checks, urine protein testing, and fetal growth assessments, is cardinal for early detection and effective management of high-risk individuals.

Pregnancy termination is a global concern affecting millions of women, with less developed countries bearing a disproportionate burden. Despite progress in maternal healthcare, limited access to sexual and reproductive health services, and socio-economic disparities continue to contribute to high prevalence of pregnancy termination. This study aimed at understanding the contextual factors associated with pregnancy termination among married women in less developed countries based on the socio-ecological model.The study analysed data from 61 developing countries’ Demographic and Health Surveys (2015–2022) among non-sterile, fecund women (n = 715,281). Univariate, bivariate, and binary multilevel regression analyses were conducted to examine individual, household, and community-level factors associated with pregnancy termination. Model fit was assessed using the Akaike Information Criterion, and Stata 17 was used for statistical analysis.The multilevel regression analysis revealed that pregnancy termination is significantly high (18.5%) in LDCs, and is influenced by individual, household, and community-level. Among the individual factors, older married women (AOR = 2.50, 95% CI: 1.83–1.80–1.87 and AOR = 2.50 95% CI: 2.54–2.56), with primary education or higher (AOR = 1.15, 95% CI: 1.22 – 1.17; AOR = 1.20 95% CI: 1.17–1.22 and AOR = 1.10, 95% CI: 1.07–1.13) and in employment exhibited increased odds of termination. Partners education and higher household wealth were household factors associated with pregnancy termination. At community level, wealth index, media and family planning message exposure and contraceptive use (AOR = 1.05, 95% CI: 1.02–1.08 and AOR = 1.03, 95% CI: 1.01–1.05) were associated with termination.The study reveals that pregnancy termination among married women in LDCs are shaped by a mix of individual, household, and community factors. Women who are older, more educated, and employed are more likely to terminate a pregnancy, as are those with educated partners and from wealthier households. Additionally, increased exposure to media and family planning messaging correlates with higher termination rates. These findings underscore the need for a comprehensive policy approach to enhance women’s reproductive health in LDCs. Such a strategy should include individual through to community-level interventions focused on empowering women, engaging men, improving access to family planning services, and implementing destigmatising media campaigns. These combined measures would contribute significantly to ensuring that no woman is left behind in meeting their SRH needs

People living with HIV (PLHIV) who do not achieve viral suppression on antiretroviral therapy contribute to HIV transmission. Poor adherence is a major factor associated with high viral load (VL). Enhanced adherence counseling (EAC) is a targeted intervention to improve adherence and achieve viral suppression, but data on post-EAC outcomes in Zambia remain limited. This study assessed viral suppression and associated factors among PLHIV with unsuppressed VL after completion of EAC at University Teaching Hospital and Kanyama First-Level Hospital. This retrospective cohort study analyzed VL register data from 1st January 2021–31st December 2023. Baseline demographic, clinical, and laboratory data were collected, with follow-up VL measurements at three and 12 months post-EAC. The primary outcome was viral suppression at three months, defined as a VL < 200 copies/mL. Poisson regression with robust standard errors identified factors associated with suppression. Among 386 participants (median age 39 years, IQR: 31–47), 52.9% were female. The baseline VL was 21,600 copies/mL (IQR: 3,692–106,000). At three months post-EAC, 85% (330/386) achieved viral suppression, with 95.8% (316/330) maintaining suppression at 12 months. Viral rebound occurred in 4.2% (14/330). EAC delivered through both telephone and in-person methods increased suppression likelihood by 15% compared to those who received EAC in-person (physical) alone. Prior enrollment in six-month multi-month dispensing (MMD) was associated with a 23% increased likelihood of suppression compared to those who had never received MMD. Participants on tenofovir/lamivudine/dolutegravir were 29% more likely to suppress compared to those on zidovudine/lamivudine/dolutegravir. EAC modestly improves and sustains viral suppression among PLHIV with high viral loads. In-person and telephone-based EAC improved viral suppression by 15% compared to in-person alone. Other key factors influencing suppression were community-based delivery and prior six-month MMD. Findings highlight opportunities to integrate technology-enhanced adherence support and differentiated service delivery models to optimize HIV care outcomes.

Acute kidney disease (AKD) contributes significantly to morbidity and mortality, particularly in low-resource settings where limited diagnostic capacity often leads to delayed recognition and suboptimal management. We aimed to evaluate the impact of implementing a comprehensive patient-specific clinical laboratory support on clinical outcomes in AKD and to identify factors associated with mortality. We conducted a mixed-method hybrid type 3 implementation study at Livingstone University Teaching Hospital in Zambia. The study compared a retrospective non-intervention cohort (NIC; n = 39) with a prospective intervention cohort (IC; n = 39) matched for age and sex. The intervention included providing full laboratory diagnostic support for AKD management and additional patient-specific tests. The primary outcome was death within 30 days after admission regardless of whether the patient was discharged before or after the thirty-day period elapsed. Data were analyzed using logistic regression and survival analysis. The median age of the NIC (43 years, IQR 31–53) was comparable to the IC (41 years, IQR 34–53), p = 0.996. Overall, 51.3% (n = 40/78) were males. Mortality rate was significantly lower in the intervention group, with deaths occurring in 5.1% of the IC compared to 28.2% in the NIC (p = 0.012). Logistic regression confirmed the intervention as a strong independent predictor of survival (adjusted odds ratio 0.07, p = 0.009). Diagnostic accuracy improved, with fewer cases of misdiagnosis or delayed diagnosis in the IC (7.7% vs 30.8%, p = 0.019). Re-hospitalization was significantly lower in the IC (38.6% vs 61.4%, p = 0.022). ESRD was more frequently recorded in the IC due to better diagnostics, follow-up and survival. The median time-to-ESRD was substantially longer in the IC compared to NIC (140 vs 21 days, p < 0.0001). Implementation of a comprehensive patient-specific clinical laboratory support for AKD/CKD management significantly improved diagnostic precision and survival and reduced re-hospitalization. These findings highlight the value of strengthening laboratory diagnostic capacity to improve AKD outcomes in low-resource settings.

In this paper, the main objective was to analyse the influence of exchange and interest rates on volatility persistence using asymmetric GARCH models (EGARCH and TGARCH) on NSE data. The analysis of the relationship between stock return volatility, exchange, and interest rates on volatility persistence was performed using the models ARMA (1, 2) -EGARCH (1,1) and ARMA (1, 2) -TGARCH (1,1) under the student t distribution and the generalised error distribution assumption using the NSE daily 20-share price index, interest rates, and exchange rates from 02/01/2015 to 31/12/2024 accounting for 3106 observations. The degree of persistence in the conditional variance equations slightly increased for the ARMA(1,2)-TGARCH(1,1) model and there was a slight reduction for the ARMA(1,2)-EGARCH(1,1) with the inclusion of interest rate and exchange rate which was consistent regardless of the error term distribution assumption. Generally, information shocks increase volatility persistence, and negative shocks have a greater impact than positive shocks. The coefficient of the exchange rate ($\delta_2$) is positive and statistically significant for ARMA (1,2)-TGARCH (1,1). Hence, we deduce that the volatility in the NSE can be explained by the exchange rate, and there exists a positive relationship. Therefore, it is evident that stock returns are positively related to changes in exchange rates. The government should implement policy measures to control the exchange rate, such as real-time disclosure of financial information, trading volumes, and corporate actions, as these affect stock returns.

Abstract BackgroundThe universal test-and-treat (T&amp;T) policy has improved HIV outcomes but may influence hypertension (HTN) risk due to prolonged antiretroviral therapy (ART) exposure. We compared HTN prevalence and risk factors among PLHIV before and after T&amp;T implementation in Zambia.MethodsA retrospective cohort study analyzed 6,409 PLHIV (2,920 pre-T&amp;T and 3,489 post-T&amp;T) from 12 Southern Province districts. Data on demographics, ART regimens, blood pressure, and laboratory measures were extracted from electronic (SmartCare) and paper records. Multivariable logistic regression identified HTN-associated factors (p&lt;0.05).ResultsHTN prevalence increased from 8.8% pre-T&amp;T to 10.2% post-T&amp;T. Each year of age increased HTN odds by 5–6% in both cohorts (adjusted odds ratio [AOR]: 1.06 pre-T&amp;T, 1.05 post-T&amp;T p&lt;0.0001). Urban residence was protective (AOR: 0.72 pre-T&amp;T, 0.67 post-T&amp;T p≤0.041), while males had higher HTN risk than females (12.2% vs. 8.8% post-T&amp;T p=0.0015). Post-T&amp;T, higher hemoglobin marginally increased HTN odds (AOR: 1.08; p=0.049). INSTI-based regimens rose from 26.3% to 41.5% post-T&amp;T but showed no significant association with hypertension on multivariate analysis. Rural residents had higher HTN prevalence (11.5% vs. 8.4% urban post-T&amp;T p=0.0027).ConclusionsHTN prevalence increased post-T&amp;T, and was driven by aging and potentially ART-related metabolic effects. Urban residence was unexpectedly protective, possibly due to better healthcare access. The hemoglobin-HTN link post-ART warrants further study. Strengths include a large, representative sample, though unmeasured confounders (e.g., lifestyle factors) and retrospective design limit causal inferences. Integrated HTN screening in HIV programs is critical to address this growing burden.