Northrise University

Abstract Antimalarials are central to Zambia’s strategies for malaria control and elimination. Antimalarial drug resistance poses a significant threat to the effectiveness of artemisinin-based combination therapies and preventive strategies such as sulfadoxine-pyrimethamine chemoprevention in pregnant women. In this genomic surveillance study, dried blood spots and epidemiological data were collected from confirmed Plasmodium falciparum cases at 61 health facilities across all 10 Zambian provinces from March to July 2023. A total of 2,486 samples were genotyped using multiplexed amplicon sequencing to identify mutations in 12 genes associated with resistance to seven antimalarial drugs. Several mutations potentially associated with artemisinin partial resistance were identified, including the validated k13 P574L marker (0.66% adjusted national prevalence) and the candidate k13 P441L marker (1.39%). The distribution of mutations was heterogeneous, with many health facilities reporting resistance markers in more than 5% of infections, and in some instances, up to 46%. The mdr1 N86 genotype, associated with decreased lumefantrine susceptibility, was found in all samples. Very high levels of sulfadoxine-pyrimethamine resistance markers were observed, including dhps K540E (93.26%). The variable prevalence of resistance markers underscores the need for routine molecular surveillance to detect emergent resistance and guide malaria control strategies. These results also call for studies to understand the clinical implications of these mutations and ensure the continued efficacy of antimalarial interventions in Zambia.

Renal angiomyolipomas (AMLs) are classified as typical (classic) or atypical renal AMLs. Eighty per cent of renal AMLs occur sporadically, with a female preponderance (4:1) and a mean age of presentation of about 40 years. The remaining 20% are associated with genetic disorders. Most AMLs are discovered incidentally during imaging or surgery performed for other conditions. Treatment options include partial nephrectomy (nephron-sparing surgery), radical nephrectomy, embolization, cryoablation, or percutaneous radiofrequency ablation. We report a case of renal AML managed by radical nephrectomy at Ndola Teaching Hospital in north-central Zambia.

Erectile dysfunction is a prevalent urological problem affecting 3%-76.5% of men globally, yet its prevalence and associated factors in Zambia remain unknown. Therefore, this study aimed to investigate the prevalence of erectile dysfunction and associated factors among adults accessing services at Ndola Teaching Hospital from 2017 to 2022. This retrospective cross-sectional study involved 500 male patients from 2017 to 2022, both with and without erectile dysfunction. The study used Stata/SE version 17 for univariate and multiple logistic regression analyses, with a p-value of <0.05 indicating statistical significance. The prevalence of erectile dysfunction was found to be 34.7%. Formal employment (AOR 0.38; 95% CI: [0.15 – 0.94], p = 0.037), married (AOR 0.35; 95% CI: [0.13 – 0.95], p = 0.039), single (AOR 0.09; 95% CI: [0.02 – 0.35], p = 0.001), and widowed (AOR 0.03; 95% CI: [0.01 – 0.13], p < 0.001) were associated with a reduced risk of developing erectile dysfunction. Drinking alcohol (AOR 8.50; 95% CI: [3.98 – 18.16], p < 0.001), diabetes mellitus (AOR 34.3; 95% CI: [13.75 – 85.60], p < 0.001), hypertension (AOR 3.90; 95% CI: [1.77 – 8.59], p = 0.001), anti-depressants (AOR 17.2; 95% CI: [6.18 – 47.92], p < and Obesity (AOR 28.8; 95% CI: [2.42 – 343.99], p = 0.008) were associated with increased risk of developing erectile dysfunction. The study revealed that erectile dysfunction is a prevalent problem among men, with several risk factors identified, emphasizing the need to address these to prevent and effectively treat the condition.

This paper proposes a novel method of extracting similar and invariant parameters from exited electrocardiogram (ECG) for enhanced authentication of non-rest state subjects. We offer a method of accurately predicting excited fiducial domains even when participants submit ECG data that is collected during different states of excitement. Rest state ECG is obtained and used as baseline. Multiple ECGs are obtained from human subject at various excitement levels. The excited ECGs are superimposed on rest state ECG baseline to obtain invariant fiducials domains which are used to model generic predictor vectors. The predictor vectors can now be used (applied) on other unexcited subject ECG to predict their exited fiducial domains. By combining traditional rest state baseline ECG authentication methods with our excited fiducial domain predictor method, we envisage enhanced True Acceptance Rate (TAR) authentication in spite of the subject’s state of rest or excitement. Results indicates that exited subjects were authenticated with TAR exceeding 50% in spite of them only initially submitting rest state ECG baseline data. Authentication rate declined with increased activity rate achieving 100% TAR authentication for subjects at rest, 84% TAR for both walking and brisk walking subjects and 58%TAR for jogging subjects.

Governments, both central and local authorities, have embraced the concept of e-Governance. This study sought to determine the extent of e-Government implementation by local authorities in Zambia by assessing the availability of websites/web portals, online services, and other e-Government systems in local authorities. The study also sought to establish the possible e-Government implementation challenges in local authorities. A quantitative research design approach and a survey strategy were adopted. In this regard, 35 local authorities out of 116 local authorities were purposively selected to take part in the study. Data was collected using a questionnaire and observation checklist. The findings show that only 5 (14.29 %) of local authorities have websites/web portals that provided mainly basic information, except for the website for the Lusaka city council which provided online services including online payment. Further, it was established that all the councils have Facebook pages where they provide information and engage the public. Furthermore, all the surveyed councils practice e-procurement using the Zambia e-Government Procurement platform for Zambia Public Procurement Authority. The majority (70%) of local authorities reported having several challenges which include inadequate funding, limited ICT infrastructure, and lack of skilled IT, intermittent power supply, and unstable internet connectivity.

Data summarization and presentation skills, as well as data analysis skills through the application of statistical tests, are important skills that every graduate student must master. These skills enable researchers to reach research conclusions and recommendations. The main purpose of this work is to first describe the best selection of tables and graphs for examining and describing various aspects of the data in the study. Second, we describe the relationships between variables and trends in study data and discuss the selection of the most appropriate statistical tests for examining them. The methodology used in this study was descriptive as it discussed and explained how the data were presented and analyzed. This white paper will therefore consist of two parts: Part 1 focuses on summarizing and presenting data using tables and graphs, while Part 2 focuses on data analysis by applying various statistical tests.

The challenges of technology in African countries, with a focus on Zambia, are numerous and complex. While technology has the potential to greatly benefit these nations, it also presents significant hurdles that must be overcome. One of the primary challenges is the lack of infrastructure. Many African countries, including Zambia, have limited access to electricity and internet connectivity. Without reliable power sources and a strong telecommunications network, it is difficult for these nations to fully embrace and utilize technology. This hampers economic development and limits opportunities for education and innovation. Another challenge is the high cost of technology. In many African countries, the average income is low, making it difficult for individuals and businesses to afford expensive technological devices and services. This creates a digital divide between those who can afford access to technology and those who cannot. As a result, many people are left behind in terms of accessing information, job opportunities, and social connections. Additionally, there is a lack of technical skills among the population. While there may be some individuals who are proficient in using technology, overall, there is a shortage of trained professionals who can develop and maintain technological systems. This limits the ability of African countries to fully harness the potential benefits of technology. Furthermore, there are cultural barriers that impede the adoption of new technologies. In some cases, traditional beliefs or practices may clash with modern technological advancements. For example, in rural areas where agriculture is prevalent, farmers may be resistant to using new farming techniques or equipment because they prefer traditional methods passed down through generations. Moreover, cybersecurity threats pose significant challenges for African countries as they strive to embrace technology. With limited resources dedicated to cybersecurity measures, these nations become vulnerable targets for cyberattacks that can disrupt critical infrastructure or compromise sensitive data. Despite these How to cite this paper: Kala, E.S.M.

Objective: This qualitative study explored the barriers towards the uptake of Bilateral Tubal Ligation (BTL) among grand-multiparous women. Study design: The study used an exploratory qualitative methodology. Study Setting: research participants were drawn from the Copperbelt communities. Study Population: Grand multiparous women Methods: Semi-structured interviews were utilised to collect data. Twenty-five semi-structured interviews were held with grand multiparous women who were attending clinics for family planning services. All interviews were audio recorded and transcribed verbatim. A thematic approach underpinned by some aspects of the Silences Framework was utilised for data analysis. Results: The study revealed that barriers to the uptake of BTL included desire to maintain productivity, pressure from spouses, stigmatisation of family planning, safety fears and loss of self-esteem. Conclusion: our findings show that there is need to engage women in communities to make sure that their family planning needs are effectively addressed. Key words: Multiparity, Women, Bilateral Tubal Ligation, Mortality

Introduction: Dialysis is the primary kidney replacement therapy for patients with kidney failure in sub-Saharan Africa. We assessed the rates and predictors of early mortality in Zambian patients starting chronic dialysis. Methods: This retrospective study included all patients who started chronic haemodialysis (HD) or peritonealdialysis (PD) between 1 January 2017 and 31 August 2020 at the three largest public dialysis centres in Zambia. Data on clinical, laboratory and dialysis characteristics were extracted from medical records. The primary outcome of interest was the mortality rate at 90 days. Results: A total of 154 patients were included in the study; 43.5% were female and 32% were 50 years or older.The main causes of kidney failure were hypertension (59%), glomerulonephritis (10%), HIV/AIDS (10%) andunknown (8%). The mortality rate at 90 days was 12.3%. Of these, 42% were cardiovascular-related mortalities and 32% died of infection related to central venous catheters. The lymphocyte percentage of total white blood cells was lower in patients who died compared to survivors (12.7 vs 20.8%) and was an independent predictor of early mortality (OR 0.914, 95% CI 0.850–0.983; P = 0.015). Conclusions: Early mortality was high in Zambian patients starting dialysis, and a low lymphocyte percentage was a predictor of mortality. Keywords: kidney replacement therapy, dialysis, Zambia, mortality

Introduction: Colorectal cancer (CRC) is a global public health problem that requires early diagnosis and management to decrease mortality and morbidity. Yet, despite the existence of international CRC screening guidelines and recommendations, CRC screening is rarely practiced in most African countries and Zambia is no exception. We conducted a survey to understand the knowledge, attitudes, and practices about colorectal cancer screening among medical doctors in Zambia and assessed treatment referral patterns. Methods: A multi-institutional cross-sectional study of all registered medical doctors working in Zambia using a self-administered online structured survey was carried out. The survey comprised of 23 standardized qualitative and quantitative questions. Descriptive analysis was used to describe frequencies of the variables; chi square analysis was used to determine associations between knowledge, attitudes and practices and multiple logistic regression was used to describe associations between knowledge of CRC screening and referral patterns. Statistical significance was evaluated at P <0.05. Results: Out of 243 medical doctors, 147 medical doctors completed the survey giving us a response rate of 61%. Of the respondents 93 (63.3%) were male, with mean years in clinical practice of 3 years (± 3.4 years). Most see about 60 patients per day. One-third (n=50, 34%) of respondents had good knowledge on the appropriate age of initiation of CRC screening, while almost all (n=138, 95.2%) had poor knowledge on the screening modalities of CRC. Three-fifths (n=84, 60%) exhibited poor attitudes towards CRC, while more than half (n=86, 58.5%) report having referred patients for some form of CRC treatment in past year. There was no association between the knowledge and attitude towards screening (P= 0.948) or knowledge of CRC screening practices (P= 0.414) and referral patterns (P=0.433). Provider factors associated with CRC screening include a reduced clinic patient volume (P= 0.0176), and patient factors include family history of ulcerative colitis (P= 0.0151), having at least one first degree relative with CRC younger than 50 (P=0.0542), and knowledge that screening impacts management (P= 0.0571). Conclusion: The poor colorectal cancer screening knowledge and attitudes among medical doctors in Zambia suggests a need for studies that explore the magnitude of association between knowledge and practices to help establish national screening guidelines.