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with support from the UN Population Fund (UNFPA)
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available by the Population Information Network (POPIN)
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ZAMBIA HEALTH INFORMATION DIGEST
Volume 1, Number 1 October-December 1994
Published by the university of Zambia Medical Library
In Association With:
The Ministry of Health of Zambia
The Health Foundation of New York
A Grant From The IBM Corporation
==================================================================
ZAMBIA HEALTH INFORMATION DIGEST
EDITORIAL BOARD
Dr. Andrew L.Mbewe Paediatrician,
University Teaching Hospital.
Dr. Michael Wolff Department of Community Medicine,
University of Zambia
Dr. Peter Songolo Medical Officer,
Kafue Gorge Hospital
Ms R. Shakakata Librarian,
University of Zambia Medical Library
Mr. Ignatius Lungu Assistant Librarian,
University of Zambia Medical Library
Mr. Edgar Chani Health Information Department,
Ministry of Health
Dr. Katele Kalumba Deputy Minister of Health.
Dr. Mannasseh Phiri Executive Director,
Zambia Flying Doctor Service
ADDRESS:
Zambia Health Information Digest
Medical Library
University of Zambia
School of Medicine
P.O. Box 50110
Lusaka
Zambia
Telephone: 260-1-250801
Fax: 260-1-250753
E-mail: Medlib@zam.healthnet.org
Medlib@p1.f1n761.z5.fidonet.org.
AIM
The Zambia Health Information Digest is produced to provide
current information to health workers who have little access to
current health related publications and information.
Source
The abstracts of Journal articles published in this quarterly
digest are obtained from the MEDLINE databases provided by the
Health Foundation of New York. Abstracts are also selected from a
database of Zambian health articles, which is continually being
compiled at the UNZA Medical Library. Readers are encouraged to
send in their work for inclusion in this Zambian health information
database. Computer equipment has been supplied through a grant from
the IBM corporation. Subjects that are prominently reflected on the
medical library's MEDLINE search requests and information on
prevalent health conditions seen in Zambia are published. Other
health related subjects are also included. The Health Sciences
centre Library at the University of Florida will supply photocopies
of the full text articles to the University Medical Library (UTH)
after the digest is compiled. The offprints will be supplied to
readers on request. When available in the library, the cost of the
photocopies will be K100.00 per page*. The total number of pages
of the full article will be indicated after each publication.
Production costs are supported by The Health Foundation of New
York. We encourage readers to submit requests for articles
highlighted in the digest.
*For the inaugural issue, offprints will be supplied to those who
request them for free!
Custom Searches
Using the MEDLINE compact disc databases, custom searches can be
done on any health issue to obtain the most up-to-date information
available. Readers are encouraged to submit requests for searches
on relevant health problems which they face. Requests should be
sent to the Medical Library, attention Mr. Lungu.
=================================================================
Zambia Health Information Digest
October - December 1994
Table of Contents
Editorial
Current abstracts of Journal articles
Medline
-Persistent diarrhoea and rice based diet
-Parents with HIV versus children's perception
-Secretory IgA and HIV infection
-Kaposi's sarcoma and radiotherapy
-The new role of community nurse
-Steroids and athletes
-Malaria chemosuppresion and pregnancy
-Endemic African kaposi's sarcoma
-Bacterial meningitis
-Anaemias and leukaemias
-Sickle cell anaemia and proteins
-Deaths in paediatric wards
-Nutrition and respiratory failure
African Index Medicus for Zambia
-Home Management of Acute Diarrhoea in Zambia
-Nutrition Manual for Health Care Workers in Zambia
-Aids Among Street Adolescents in Lusaka
-Clinical Management of HIV Infected Patients in Zambia
Common medical conditions in Zambia
Dr. A. L. Mbewe
- Acute Respiratory Infections in children
- Management of Acute Respiratory infections
HealthNet in Zambia
Ms. Regina Shakakata
Institutional Profile
Dr. M.A. Banda
- Churches Medical Association of Zambia
Current News from Health Related Seminars and Workshops
-Information on and Application for the Upcoming
Problem Solving for Better Health Workshop
Author Index
===================================================================
LAUNCHING REMARKS
Provided by Dr. Katele Kalumba
Deputy Minister of Health for Zambia
The Zambia Health Information Digest (ZHID) is an important
development in the provision of health information to health care
workers. Reflecting back on the expansion of our country's health
facilities from only 352 facilities at independence to over 1000
health institutions today; I realize that the country's good health
services infrastructure has not been matched by an equally good
health information network. Although our health care workers
created channels for disseminating health information, like The
Medical Journal of Zambia, and Bwino; their production and
circulation were erratic, due to many factors, including financial
limitations. The importance of the ZHID is its focus on health
information for problem solving within individual health
institutions, especially those in the periphery. The development
of ZHID is very much in the spirit of the Zambia Health Reforms of
1992. Special features of ZHID include its' concentration on
practical information for Zambia's average health worker; and the
digest's focus on interactivity by offering to do custom medical
information searches as well as including abstracts of local health
articles. The international scope of the digest will give its
readers international perspectives on local health problems. We
hope that these features will help the digest have a greater impact
on health workers and their patients.
The project, which started as a program for automated CD-Rom
literature searches at the Medical Library has now become
accessible to the wider circle of all health care workers in
Zambia, through the digest's distribution. Take note that ZHID
will be circulated to Rural Health centers Stages I and II;
District, General, Special Care and Central Hospitals for its very
first issue. Distribution will expand further eventually to
provide even greater access to the current and relevant medical
information housed at the UNZA Medical Library. The digest will be
circulated to as wide a range of recipients as possible
I am mindful of the circulation and production costs of such
a large constituency and realize that information has a high value.
The government of the Republic of Zambia does not intend to
spoon-feed its people any longer; and the Ministry of Health is
committed to cost-sharing. The patient contribution policy which
has been adopted by the Ministry of Health will only be viewed as
being earnest if and when the health care workers are seen to pay
for access to health information. Consequently, the editorial
board of ZHID, the Ministry of Health, The University of Zambia
Medical Library, The Health foundation of New York, and IBM should
confer and recommend a period of not less than two years for
marketing the digest free of charge. Thereafter a scheme for an
affordable subscription fee will be instated.
I have been informed by the UNZA Medical Library, that in
early February 1995, The Director of The Health Foundation, along
with members of his staff, will visit Zambia to launch even more
problem-solving efforts in Zambia. We welcome this development
and those like it.
I wish to conclude by acknowledging all the people who made
the production and distribution of this digest a reality.
Message from THE HEALTH FOUNDATION of New York
Greetings to all our colleagues in Zambia! This first issue of the
Zambia Health Information Digest is an extremely important event.
We are honoured and delighted to be part of it. As you may know,
the Digest is part of The Health Foundation's INFO-MED Program in
Zambia -- an effort to improve access to, utilization of, and the
ability to share relevant, international, national, and local
health information for a wide range of health professionals
including physicians, nurses, environmental health officers,
sanitary engineers, health administrators, rehabilitation
specialists, social workers, community health workers, health
administrators, community leaders -- anyone who is working for the
better health of the Zambian people.
In the end what the Digest and INFO-MED are all about is very
simple: achieving better health. And it is the extent to which it
contributes in a real, measurable way to better health that is its
only criterion of success. There is no "magic" in the INFO-MED
Program per se. It is not about, nor does it belong to, The Health
Foundation. You, the users and contributors to it, and what you do
with it, are the secrets to its success. Without you and your
input, it will not work. We hope that the Digest will be well used,
reaching every corner of Zambia, and that health workers from
every corner of Zambia will not only learn from it, but also
contribute their knowledge and experience to it and to the database
of health solutions that will exist in the central computer files.
The solutions to be found in that database will come from Zambia
and many other countries and so that what is learned in one place
will be shared worldwide. In this way we can all benefit from each
of us know and have learned. INFO-MED is meant to be a dynamic,
interactive process of learning and sharing of solutions to health
problems -- and putting the solutions into action.
It is not a passive, static repository of information. It is an
approach, along with THF's "Problem Solving for Better Health"
Program (to be launched in Zambia in early 1995), to taking action
for better health -- to making a difference for health NOW! We are
glad to have you join the worldwide family of INFO- MED and Problem
Solving for Better Health. You will make it much stronger. Thanks
for joining us and being our colleagues, friends, and teachers. We
look forward to learning from, and with you. Working together, we
can make an enormous difference for better health!
Dr. Barry H. Smith, MD, PhD
Shana Flynn Raggio
Adam Charles Greenberger
=================================================================
CURRENT ABSTRACTS
PERSISTENT DIARRHOEA AND
RICE BASED DIET
A diet based on rice powder, soya-bean
oil, glucose, egg-white and salts was
given to twenty-six patients of different
nutritional status aged 4-18 months with
persistent diarrhoea and twenty-five
age-matched controls without diarrhoea.
Clinical response was monitored during
1week of dietary treatment and
absorption of macronutrients was
estimated during a 72 h balance study.
Twenty-one patients (81%) recovered
from diarrhoea within 7 d. There were
significant relationships between
nutritional indices, recovery, and
absorption of total energy, fat and N. The
absorption of fat, protein and
carbohydrate in the better nourished
controls without diarrhoea was
significantly higher than in patients with
persistent diarrhoea with better nutrition
or malnutrition. The duration of diarrhoea
was significantly longer in lighter patients
(weight-for-age < 65% NCHS (1976)
standard), in wasted patients
(weight/height < 80% of
NCHS) and those with mid upper arm
circumference (MUAC) less than 110
mm. There were negative relationships
between the period of recovery and the
coefficient of absorption of fat (P <
0.001), total energy intake (P < 0.01) and
MUAC (P < 0.05). Weight-for-age and
MUAC showed most effective
discriminative power for absorption of
nutrients. However, the coefficients of
absorption for carbohydrate were not
different for any pair of nutritional
groups. Absorption of all nutrients was
also correlated negatively with severity of
persistent diarrhoea on admission. The
results of the present study indicate that a
rice-based diet is highly effective in the
management of persistent diarrhoea and
less malnutrition aggravates nutrient
malabsorption, increases duration and
severity of diarrhoea and less severely
malnourished patients do not absorb
nutrients as well as healthy controls.
Malnutrition and the initial severity of
diarrhoea are significant determinants of
clinical prognosis and nutrient absorption
in persistent diarrhoea.
Roy SK. Akramuzzaman SM. Haider R. Khatun
M. Akbar MS. Eeckels R.
Persistent diarrhoea: efficacy of a rice-based diet
and role of nutritional status in recovery and
nutrient absorption.
British Journal of Nutrition. 71(1):123-34, 1994
Jan.
PARENTS WITH HIV VERSUS
CHILDREN'S PERCEPTION
OBJECTIVE: To investigate the
likelihood of patients who have human
immunodeficiency virus/acquired
immunodeficiency syndrome (HIV/AIDS)
being parents and to identify concerns of
these parents about their children.
DESIGN: A survey was conducted of
parental status, demographics, perceptions
of social/emotional needs of self and
one's children. Responses were analyzed
for demographic differences.
PARTICIPANTS: A total of 242 patients
from the university HIV/AIDS clinics
completed the survey.
MAIN OUTCOME MEASURES: Parental
status, number, and ages of children,
parental concerns about their children
related to their own HIV/AIDS.
RESULTS: Nearly one third (31.8%) of
the sample of HIV/AIDS patients were
parents, and three fourths (76%) of the
female patients were mothers. Slightly
more than one third of these were
married, and these were not
predominantly families who also had
infected children. The percentage of
women in the parent subsample (40.8%)
was higher than the percentage of women
in the overall patient sample (16.7%).
Only half of the parents reported that
their children > 4 years of age knew of
their diagnosis. Two thirds of the parents
reported they believed their children did
not need to talk to someone about their
parent's health, and nearly half of the
parents reported that they did not need
help dealing with their children
concerning issues related to AIDS.
CONCLUSION. The percentage of
HIV/AIDS patients who are parents is
high, and parental status and emotional
needs of parents and their children will
likely become an increasingly important
issue. Many questions are raised by our
findings. Should we be concerned that
many parents have been unable to talk to
their children about their own health?
Should we help parents acknowledge that
their children may need some outside
help to cope?
Niebuhr VN. Hughes JR. Pollard RB.
Parents with human immunodeficiency virus
infection: perceptions of their children's emotional
needs.
Pediatrics. 93(3):421-6, 1994 Mar.
SECRETORY IgA AND HIV
INFECTION
Diarrhoea is common in patients infected
with the human immunodeficiency virus
(HIV) in Africa. There has been
speculation that HIV itself may cause
some of the enteropathy seen. The
intestinal secretory IgA (sIgA) response
was used to evaluate HIV intestinal
infections in Zambian patients with acute
and chronic diarrhoea. sIgA was extracted
from stool specimens and evaluated by an
ELISA. Seven (58%) of 12 HIV-positive
patients with acute diarrhoea and 25
(69%) of 36 HIV-positive patients with
chronic diarrhoea showed an sIgA
response to HIV p24, compared with 1 of
10 HIV-positive patients without
diarrhoea (P < .025 for acute and P <
.001 for chronic diarrhoea). The mean
duration of diarrhoea was significantly
longer in patients showing an anti-p24
response. An sIgA response to HIV
antigens occurs commonly in infected
patients with diarrhoea and may provide
further evidence of an etiologic role of
HIV in the diarrhoea associated with
AIDS.
Mathewson JJ. Jiang ZD. DuPont HL. Chintu C.
Luo N. Zumla A.
Intestinal secretory IgA immune response against
human immunodeficiency virus among infected
patients with acute and chronic diarrhoea.
Journal of Infectious Diseases. 169(3):614-7, 1994
Mar.
KAPOSI'S SARCOMA AND
RADIOTHERAPY
PURPOSE: A retrospective analysis of
patients with non-AIDS and
AIDS-related Kaposi's sarcoma, who
were treated with radiation therapy.
METHODS AND MATERIALS: Between
1978 and 1992, 56 patients with one of
the three major types (classical, endemic,
epidemic) of Kaposi's sarcoma received
radiation therapy as their sole treatment
modality. Extent of fields, daily
fractionation, and total dose were applied
on a clinical basis. These lesions received
superficial x-ray therapy, Co-60
teletherapy, or 6-8 MeV electron beams.
Field sizes depended on extent of the
lesion. Total dose administration ranged
from 8-12 Gy in one exposure, or a total
of 24-30 Gy fractionated over 2-3 weeks.
RESULTS: The majority of patients
responded to radiation therapy.
Symptomatic relief was achieved in
80-100% of patients irrespective of the
type of Kaposi's sarcoma, treatment
modality, or schedule. Side effects were
tolerable in all but three patients with
epidemic type Kaposi's sarcoma, who
developed severe mucositis.
CONCLUSION: Radiotherapy is the most
useful mode of palliative treatment for all
forms of Kaposi's sarcoma in southern
African patients. [References: 42]
Stein ME. Lakier R. Spencer D. Dale J. Kuten
A. MacPhail P. Bezwoda WR.
Radiation therapy for non-AIDS associated (classic
and endemic African) and epidemic Kaposi's
sarcoma. [Review]
International Journal of Radiation Oncology,
Biology, Physics. 28(3):613-9, 1994 Feb 1.
THE NEW ROLE OF A
COMMUNITY NURSE
Currently there is considerable
uncertainty regarding the future for
community nurses in the United Kingdom
(UK). Within the present social and
political context the development of the
nurse practitioners examined as one
possible means of redefining the role of
some community nurses. The historical
development of the nurse practitioner in
the United States of America (USA) and
the UK reveals that such a role has,
previously, been a response to changing
health trends and to deficits in the
provision of care to communities. The
evolution of an independent nurse
practitioner role is suggested as a way
forward for different groups of
community nurses and should enable
them to meet the health demands of
people in a variety of settings. The
'needs' of patients and clients and a
multidisciplinary approach are
emphasized as being important to the
redefinition of community nursing roles.
The preparation of community nurses as
nurse practitioners would have obvious
implications for community education;
this matter is briefly discussed. The
future of nursing as a whole is set to
change; it is imperative that all nurses
delivering patient care in this arena
should examine the changing needs of
society in the context of political reform,
and consider how their roles may be
developed and redefined.
Trnobranski PH.
Nurse practitioner: redefining the role of the
community nurse?.
Journal of Advanced Nursing. 19(1):134-9, 1994
Jan.
STEROIDS AND ATHLETES
BACKGROUND: We sought to expand
on preliminary findings suggesting that
anabolic-androgenic steroids produce
psychiatric effects in some athletes who
use them.
METHODS: We compared 88 athletes
who were using steroids with 68
nonusers, using the Structured Clinical
Interview for DSM-III-R to diagnose
psychiatric syndromes occurring in
association with steroid use (if
applicable) and in the absence of steroid
use. Demographic, medical, and
laboratory measures were also performed.
RESULTS: Steroid users displayed more
frequent gynaecomastia, decreased mean
testicular length, and higher
cholesterol-high-density lipoprotein ratios
than nonusers. Most strikingly, 23% of
steroid users reported major mood
syndromes--mania, hypomania, or major
depression--in association with steroid
use. Steroid users displayed mood
disorders during steroid exposure
significantly more frequently than in the
absence of steroid exposure (P < .001)
and significantly more frequently than
nonusers (P < .01). Users rarely abused
other drugs simultaneously with steroids.
CONCLUSION: Major mood disturbances
associated with anabolic-androgenic
steroids may represent an important
public health problem for athletes using
steroids and sometimes for the victims of
their irritability and aggression.
Pope HG Jr. Katz DL.
Psychiatric and medical effects of
anabolic-androgenic steroid use. A controlled study
of 160 athletes.
Archives of General Psychiatry. 51(5):375-82, 1994
..
MALARIA CHEMOSUPPRESION
AND PREGNANCY
The possible influence of maternal
malaria prophylaxis on infancy malaria
was assessed in 241 infants. Mothers of
91 infants (PROG-cohort), 99 infants
(CQ-cohort) and 51 infants
(CQ+PROG-cohort) had received
prophylaxis with daily proguanil, once
weekly chloroquine, and the two drug
combination respectively. Blood smears
of infants were examined for parasitaemia
once fortnightly. Parasitaemias were
treated with either amodiaquine, Fansidar,
or Fansidar-quinine combination. In all
cohorts, the incidence of malaria
Parasitaemias within 3 months of age was
high (overall mean = 63%). Chloroquine
released from its tissue bound form in the
CQ and CQ+PROG-cohorts did not have
significant chemosuppressive effects on
the Parasitaemias. Acknowledging that
the CQ-prophylaxis group simulated the
hypothetical control group, the cohorts
similarity in the pattern of Parasitaemias
suggested that effective maternal malaria
chemoprophylaxis during pregnancy did
not significantly influence infancy
malaria. A sharp rise in incidence around
3 months was indicative of the waning
effect of passive immunity. Sole
dependence on sub-optimal active
immunity led to another sharp rise in
incidence from 9 months onwards. The
high incidence of infancy malaria
Parasitaemias calls for increased vigilance
in their early detection and effective
treatment. Social-cultural factors within
the communities may constrain effective
disease management.
Mutabingwa TK. de Geus A. Meuwissen JH.
Malle LN. Malaria chemosuppression during
pregnancy. VI. Some epidemiological aspects of
malaria in infants.
Tropical & Geographical Medicine. 46(1):1-7,
1994.
ENDEMIC AFRICAN KAPOSI'S
SARCOMA
Endemic African Kaposi's sarcoma is a
common neoplastic disorder in the
sub-Saharan region of Africa. We present
a retrospective analysis of 47 black
patients with the endemic African
(HIV-negative) variant of Kaposi's
sarcoma treated and followed up in the
Johannesburg General Hospital between
1980 and 1990. Four patients (8%)
presented with simultaneous Kaposi's
sarcoma plus malignant lymphoma,
indicating a low but significant
association with lymphoproliferative
disorders. Of 47 patients seen, 29
presented with localized disease and were
treated by means of local radiation
therapy. Seventeen patients received
chemotherapy. The objective response
rate was > 80% irrespective of the
treatment modality. We conclude that
endemic African Kaposi's sarcoma is a
chemo-and radiosensitive tumour.
Stein ME. Spencer D. Ruff P. Lakier R. MacPhail
P. Bezwoda WR.
Endemic African Kaposi's sarcoma: clinical and
therapeutic implications. 10-year experience in the
Johannesburg Hospital (1980-1990).
Oncology. 51(1):63-9, 1994 Jan-Feb.
BACTERIAL MENINGITIS
In developed countries the mortality from
bacterial meningitis acquired outside the
neonatal period is relatively low. In
contrast, in developing countries it is
often higher (20%-40%). In developed
countries despite (and perhaps because
of) the introduction of increasingly potent
antimicrobials, the morbidity of bacterial
meningitis has remained high. For
example, up to 25% of patients with
Haemophilus influenza meningitis have
some form of neurological deficit.
Neisseria meningitidis is the major cause
of bacterial meningitis in many areas of
the world. A clone of Group A
meningococcus has spread from China to
cause the most recent major epidemic in
Sub-Saharan Africa. Group B
meningococcal infections causing
sporadic meningitis are increasing in
parts of Europe and South America. The
mortality from meningococcal disease is
greatest when there is a septicemic
component to the infection. Although
antimicrobial chemotherapy is of major
importance some adjuncts to therapy are
beneficial. High dose corticosteroid
therapy has been shown to decrease
mortality in pneumococcal meningitis in
an uncontrolled study and to speed
recovery and decrease neurological
sequelae in H. influenza meningitis.
Nevertheless to prevent infection would
be of greater benefit. Prevention can be
achieved by either chemoprophylaxis or
immunoprophylaxis. Although safe and
effective vaccines are available to prevent
pneumococcal, H. influenza (Hib) and
Groups A and C meningococcal
meningitis; apart from the protein
conjugate Hib vaccine they are less
effective in children under two years of
age. There is no effective vaccine to
protect against group B meningococcal
meningitis.
Hart CA. Cuevas LE. Marzouk O. Thomson AP.
Sills J.
Management of bacterial meningitis. [Review]
Journal of Antimicrobial Chemotherapy. 32 Suppl
A:49-59, 1993 Jul.
ANAEMIAS AND LEUKAEMIAS
Forty two patients who were seen and
satisfied the French-American-British
(FAB) diagnostic criteria for
myelodysplastic syndromes (MDS) over a
6-year period at the University of
Zimbabwe's Department of Haematology,
Harare, are presented. Their overall ages
ranged from 29 to 75 years with a mean
+/- SD of 57.8 +/- 11.2 years. Males
outnumbered females with a male to
female ratio of 1.2:1. Refractory anaemia
(RA) occurred in 33.3%; refractory
anaemia with ringed sideroblasts (RARS)
in 16.7%; refractory anaemia with excess
blasts (RAEB) in 21.4%; refractory
anaemia with excess blasts in
transformation (RAEB-T) in 16.7% and
chronic myelomonocytic leukaemia
(CMML) in 11.9% of the patients. In
90.5% the disease was primary and in
9.5% prior exposure to myelotoxic agents
resulted in secondary MDS. The study
reveals that MDS as a cause of anaemia
in the African population is usually
hidden in the big number of well known
ANAEMIAS due to rampant malaria,
malnutrition and a host of nutritional
deficiencies. There is therefore the need
to increase diagnostic awareness among
our clinicians about the existence of these
disorders.
Mukiibi JM. Paul B.
Myelodysplastic syndromes (MDS) in Central
Africans.
Tropical & Geographical Medicine. 46(1):17-9,
1994.
SICKLE CELL ANAEMIA AND
PROTEINS
Transport proteins, acute-phase reactant
proteins (APRP), haematology, and
anthropometry were studied in 34 sickle
cell disease (SCD) children (20 boys, 14
girls) and 23 controls without growth
deficits (11 boys, 12 girls). The age range
was 1/2 to 16 1/2 years. Weight deficits
(< 80%) by Waterlow's classification
were observed in 41% of SCD boys and
25% of SCD girls, and height deficits (<
90%) were observed in 25% SCD boys
and 25% girls. Mean white blood cell
counts were significantly higher (P <
.001) and haematocrit and haemoglobin
(Hb) lower (P < .005) in SCD children
than in controls. Although both groups
had similar mean levels of albumin,
transferrin, and APRP, SCD children had
significantly lower mean levels of
retinol-binding protein (RBP) (P < .001)
and retinol-prealbumin (P <.001).
Retinol-binding protein levels were
abnormal in 18 (53%) SCD children and
in only 23% controls (chi 2 = 14.06; P <
0.005); transferrin levels were abnormal
in 20% of SCD children and in none of
the controls. Children with SC and SF
Hb phenotype had normal mean levels of
RBP, whereas those with S beta thal and
SS phenotype had levels below normal.
Growth-retarded children by weight and
height had reduced mean levels of RBP
and prealbumin compared with
growth-normal SCD children. The
implication of primary protein-energy
malnutrition on growth retardation in
SCD children is under study.
Warrier RP. Kuvibidila S. Gordon L. Humbert J.
Transport proteins and acute phase reactant proteins
in children with sickle cell anemia.
Journal of the National Medical Association.
86(1):33-9, 1994 Jan.
DEATHS IN PAEDIATRIC WARDS
The 461 0-2-year-old children admitted
to the paediatric ward of the National
Hospital in Niamey over a 2-month
period were closely followed up from
admission to discharge or death. The
in-hospital mortality rate was 30 per cent,
a great proportion of deaths occurring
during the first 24 hr of hospitalization.
Malnutrition was highly prevalent (76 per
cent). Children referred from other health
facilities (72 per cent) did not experience
a higher probability of survival. Using
multivariate analysis, three variables
remained significantly associated with
death: nutritional status, consultation of a
traditional practitioner, and a neonate
disease. Neonate diseases are the third
major cause of death because of a high
case fatality rate. For the other causes,
the main underlying factor is
malnutrition. Most in-hospital deaths are
due to events that occurred prior to
hospitalization. The role of hospitals'
paediatric wards of developing countries
is discussed.
Gamatie Y. Prual A. Wollo J. Huguet D.
Are paediatric wards in developing countries only
places to die? A study of prior to hospitalization
risk factors of death among 0-2 year old
hospitalized children in Niamey, capital of Niger.
Journal of Tropical Pediatrics. 40(1):54-7, 1994
Feb.
NUTRITION AND RESPIRATORY
FAILURE
Nutrition is intimately linked to
pulmonary function and an understanding
of these relationships have therapeutic
utility. Malnutrition is known to be
associated with impaired mechanical
function of the lung in both chronic and
acute respiratory insufficiency.
Refeeding results in improvement in
functional characteristics and may be
critical in the weaning of patients from
mechanical ventilation. In contrast,
overfeeding may result in an increased
ventilatory demand resulting in the
inability to wean from respiratory
support. This article considers the
background as well as recommendations
for the nutritional care of patients with
acute and chronic respiratory failure.
[References: 47]
Grant JP.
Nutrition care of patients with acute and chronic
respiratory failure. [Review]
Nutrition in Clinical Practice. 9(1):11-7, 1994 Feb.
Home Management of Acute
Diarrhoea in Zambia
A research study submitted to the School
of Medicine, Department of Post Basic
Nursing, in partial fufillment of the
requirements of a Bachelor of Sciences
degree in Nursing. The objective of the
study was to determine the factors
leading to absence of compliance to
home management of acute diarrhoea.
Although there was no correlation with
the educational status of the mothers or
their previous exposure to management of
acute diarrhoea, most of the children
came from high density areas.
===============================================================
Mthombeni, Gladyce Thokhozani
A Study of Mothers' Compliance with Instructions
for Home Care Management of Acute Diarrhoea
in Lusaka Urban District.
Lusaka: University of Zambia, 1991. pp.44
Nutrition Manual for Health
Workers in Zambia
A manual designed to address the basic
nutrition guidelines for promoting
preventive, curative, and rehabilitative
strategy issues, in order to improve the
operational capabilities of health workers
or anyone concerned with child survival
and developmental issues. It provides a
practical approach to management with
limited resources through early detection
of malnutrition and early intervention.
Ministry of Health
Nutrition Manual: The Guidelines for Health
Workers on Growth Monitoring and Promotion of
Treatment, Management, and Rehabilitation of
Malnourished Children. Lusaka: Ministry of
Health, 1993.
Aids Among Street Adolescents in
Lusaka
A research study submitted to the
Department of Post Basic Nursing,
School of Medicine, UNZA in partial
fulfilment of the requirements for the
award of the Bachelor of Sciences
Degree in nursing. The investigators
findings reveal that many street
adolescents have very little knowledge
about AIDS. Inaccessibility of health
education materials about Aids in the
vernacular. Lack of health education to
these adolescents seemed to have
contributed to their lack of knowledge.
The findings also revealed that most
adolescents had negative attitudes towards
Aids. Most adolescents also practised
unsafe sex. Those who were unemployed
practiced unsafe sex to a very high
degree.
Mukupo, Florence Chela
Knowledge, Attitudes, and Sexual Practices
Concerning AIDS among Street Adolescents in
Lusaka. University of Zambia, 1992. pp.61.
Clinical Management of HIV Infected
Patients in Zambia
Early recognition and treatment of the
complications of HIV infection improves
the well being of the patient, decreases
mortality, and prolongs survival of the
patient. It may also minimize acquisition
of opportunistic infections. Morbidity
may further be reduced by selective
chemoprophylaxis.
Himonga, H. B.; Sunkutu, M. R.
Guidelines for the Management of HIV infection
and AIDS in adults and children.
Lusaka: Zambia National AIDS Prevention and
Control Program, 1992.
Diagnosis of Paediatric
Pneumonia in Lesotho
Pneumonia causes 3.2 million deaths per year in children in
children under 5 years of age according to the World Health
Organization. In spite of the number of deaths, no single clinical
or radiological definition for the diagnosis of pneumonia is widely
accepted. To determine the extent of agreement between clinical
and radiographic diagnoses of pneumonia, we compared the clinical
diagnoses made by an experienced paediatrician with diagnoses based
on a paediatric radiologist's interpretation of chest radiographs.
In 226 children with respiratory illness brought to a hospital
outpatient department in Lesotho, Pneumonia was the clinical
diagnosis for 39 and the radiographic diagnosis for 40; however,
for only 19 children did the two diagnoses concur. Children with
a radiographic diagnosis of pneumonia tended to have been ill
longer, to be older, and to be more likely to have a technically
adequate radiograph than children with negative radiographs,
independent of the clinical diagnosis. In this comparison,
radiographic and clinical diagnoses for pneumonia differed
substantially. Some of this discrepancy may be explained by
misinterpretation of sub-optimal films and different rates of
evolution of radiographic and clinical manifestations of pneumonia.
Radiographic and clinical evaluations produced complementary data
in this evaluation: of the 60 children with clinical or
radiographic evidence of pneumonia, 14 would not have been treated
with an anti-microbial drug without radiography. Wider
availability of radiograph is needed to supplement clinical
examination for the diagnosis of pneumonia, and may be particularly
valuable in children more than 18 months old, those who have been
ill for more than 6 days, and those with fever.
Redd, C.
Comparison of the Clinical and Radiographic
Diagnosis of Paediatric Pneumonia.
London: Transactions of the Royal Society of
Tropical Medicine and Hygiene, 1994.
88. 307-310
=================================================================
Everyone at ZHID wishes a Happy
Birthday to Zambia on the
occasion of the 30 years
Independence Celebrations!
COMMON MEDICAL CONDITIONS IN ZAMBIA
ACUTE RESPIRATORY INFECTIONS IN CHILDREN
Dr. Andrew L. Mbewe is a Paediatrician working in the Department
of Paediatrics and Child Health at the
University Teaching Hospital, Lusaka, Zambia.
Acute respiratory infections (ARI) is one of the common causes of
morbidity and mortality
in infants and young children in most developing countries.
Children in East Africa get
about 4 ARI attacks per year compared to 8 attacks in West Africa.
In Zambia ARI a
major cause of morbidity and mortality. Pneumonia/Respiratory
infections is responsible
for 30% of all hospital admissions and is either the first or
second cause of deaths. In
most developing countries it accounts for 40-50% of out patient
attendances, 30-50% of
paediatric admissions and 20-50% of deaths among children aged less
than five years of
age.
Infections of the respiratory tract from the nose to the alveoli;
can be divided into upper
respiratory tract infections such as;-Coryza, Otitis media,
Sinusitis, Pharyngitis Tonsillitis.
The lower respiratory tract infections include
laryngo-tracheo-bronchitis (LT B),
bronchitis, bronchiolitis and pneumonia.
Causes
The causes of acute respiratory infections
are commonly due to viruses and
bacteria. Pneumonia is the most common
form of ARI. It contributes to 70% to
80% of ARI deaths in children. The
bacterial causes of ARI include
streptococcus pneumonia, Haemophilus
influenzal, Staphylococcus aureus, Group
B beta haemolytic streptococcus,
Eschericia Coli, Listeria Monocytogenes,
Chlamydia trachomatis. In infants less
than 2 months of age the latter four are
important causes. Viruses such as
Respiratory Syncintial Virus (RSV), para
influenza, influenzal, adenovirus and
measles are important and common
causes of severe ARI.
Predisposing Factors
Common predisposing factors for ARI
include malnutrition, low birth weight,
measles, overcrowding, in-door air
pollution, low immunization coverage
and a decline of breastfeeding. One
important reason why ARI are most
severe in developing countries such as
Zambia is because of the high prevalence
of the risk factors.
Diagnosis
The traditional approach in the diagnosis
of ARI would include examination of the
sputum and throat swab for microscopy
culture and sensitivity, a chest
radiograph, a bronchial aspirate, pleural
tap, a gastric lavage blood culture and
even a lung biopsy. The approach though
logical is usually cumbersome and time
consuming. The majority of the
population in Zambia and other
developing countries live in rural areas
which are served by relatively less
equipped health facilities and staffed by
less trained health workers. Even in the
urban areas of most developing countries
laboratory diagnosis of the causes of ARI
may be very expensive. Since the
inception of the global programme for
the control of ARI IN 1984 by the World
Health Organization (WHO), many
studies have been undertaken clinical
predictors of ARI in children . Based on
these, the WHO developed guidelines for
early detection and treatment of
pneumonia and other related ARI .
The Standard ARI Case Management
The guidelines for the management of a
child presently wit ARI were designed so
that emphasis is placed on the EARLY
RECOGNITION AND MANAGEMENT
at home and at the outpatient level, be it
at the dispensary, health centre or
hospital. The guidelines were designed
for use by mothers, fathers, community
health workers and even health workers
at secondary and tertiary health facilities.
The emphasis was targeted at early
recognition and management of
pneumonia, a major cause of deaths in
children. The recognition of pneumonia is
based on two clinical parameters which
are early detected by both parents and
health workers. These parameters are
respiratory rate and chest indrawing in a
child presenting with a history of cough
and / or difficult breathing. Such a child
undergoes a thorough ASSESSMENT;
her illness is then CLASSIFIED based on
whether the child is aged less than 2
months or the child is aged 2 months up
to 5 years as well as certain specific
signs; and finally given appropriate
Treatment.
Prevention of Acute Respiratory
Infections
Prevention of ARI requires that the risk
factors such as malnutrition, low birth
weight, infections such as measles and
over crowding are controlled. Control of
malnutrition in children will be achieved
if breastfeeding is exclusive in the first 6
months, weaning commences at 4
months, breast feeding continues for at
least 12 months, diarrhoeal diseases are
treated promptly and at least four times a
day and food is prepared and stored
hygienically.
Common infections that usually
predispose to ARI such as measles and
whooping cough will be reduced by
vaccinating children against the
immunizable infections. By vaccinating
children against measles and whooping
cough, about a quarter of pneumonia are
prevented. Vaccines against Heamophilus
influenza, streptococcal pneumoniae,
Respiratory Syncitiral Virus (RSV) and
are used in some developed countries.
Their use in the developing countries is
still limited. However a combined effort
of the above and an improved social
economic status will eventually benefit
the children in preventing ARI.
Wafula, E.M. and Onyango, F.E. (1986) Acute
Respiratory Infections in Developing Countries. E.
Afr Med J. 63.211.
Wall, R.A. et al. (1986) The Aetiology of Lobar
Pneumonia in the Gambia. Bull Wld Hlth Org.
64:553-558.
Mukelabai, K. (1992) Acute Respiratory
Infections. Primary Health Care: a Manual for
Medical Students and Other Health Workers.
Management of Children with a Cough or Difficult Breathing
The following are guidelines for Acute Respiratory Infections case
management developed
by the World Health Organization. The emphasis on early detection
and treatment of
pneumonia. Every child aged under 5 years presenting with a history
of cough and / or
difficult breathing must undergo thorough assessment, be classified
and given appropriate.
Assessment
ASK
- How old is the child?
- Is the child coughing? for how long?
- Age 2 months up to 5 years; is the
child able to drink?
- Age less than 2 months; has the young
infants stopped feeding well?
- Has the child had fever? for how long?
- Has the child had convulsions?
LOOK, LISTEN (child must be calm)
- Count the breaths in one minute.
- Look for chest indrawing.
- Look and listen for stridor.
- Listen for wheeze. Is it recurrent?
- See if the child is abnormally sleepy or
difficult to wake.
- Feel for fever or low body temperature
(or measure temperature).
- look for severe malnutrition.
Classification of Illness and its
Treatment
Acute respiratory infection(pneumonia) is
classified into very severe disease, severe
pneumonia, pneumonia and no
pneumonia (cough or cold).
Infant Less Than Two Months:
Very severe disease
SIGNS
- Stopped feeling well.
- Convulsions.
- Abnormally sleepy or difficult to wake.
- Stridor in calm child.
- Wheezing or fever or low body
temperature.
TREATMENT
- Refer urgently to hospital.
- Keep young infant warm.
- Give first dose of antibiotic.
Severe Pneumonia
SIGNS
-Severe chest indrawing
-Fast breathing (60 per minute or more).
TREATMENT
- Refer urgently to hospital
- Keep infant warm
- Give first dose of an antibiotic
- If referral is not possible, treat with
antibiotic and follow
closely.
No Pneumonia : Only Cold, or Cough
SIGNS
-No severe chest in drawing
-No fast breathing (less than 60 per
minute)
TREATMENT
Advise mother to give the following
home care:
- Keep young infant warm.
- Breast feed frequently.
- Clear nose if it interferes with feeding.
Refer to health facility quickly if:
- Breathing becomes difficult.
- Breathing becomes fast.
- Feeding becomes a problem.
- The young infant becomes sicker.
Classification of Illness and its
Treatment
Child Aged 2 Months up to 5 years:
The assessment is the same as that of the
infant less than 2 months.
Very Severe Disease
SIGNS
- Not able to drink.
- Convulsions.
- Abnormally sleepy or difficult to wake.
- Stridor in a calm child.
- Malnutrition.
TREATMENT
- Give first dose of antibiotic.
- Treat fever if present.
- Treat wheezing, if present.
- Treat malaria if present.
- Refer to hospital urgently if unable to
treat.
Severe Pneumonia
SIGNS
- Chest indrawing.
TREATMENT
- Refer to hospital urgently.
- Give first dose of antibiotic.
- Treat fever if present.
- If referral not possible, treat with
antibiotic and follow closely.
Pneumonia
SIGNS
-No chest indrawing.
- Fast breathing.
* Note: Fast breathing
-50 per minute or more if child is 2
months up to 12 months.
-40 per minute or more if child is 12
months up to 5 years.
TREATMENT
- Give an antibiotic.
- Treat fever if present.
- Treat wheezing if present.
- Advise mother to give home care.
- Advise mother to return with child in 2
days for reassessment or earlier if the
child getting worse.
No Pneumonia: Only Cough or Cold
SIGNS
- No chest indrawing.
- No fast breathing.
TREATMENT
- If coughing more than 30 days, refer
for assessment.
- Assess and treat ear problem or sore
throat if present.
- Assess and treat other problems.
- Advise mother to give home care.
- Treat wheezing if present.
*In a child who is taking an antibiotic for
pneumonia reassess in 2 days*
Status as of Reassessment Visit
(a) THE SAME
- change antibiotic or refer.
(b) IMPROVING
- breathing slower.
- less fever.
- Eating better
- Finish 5 days of treatment
(c) WORSE
- Not able to drink.
- Has chest indrawing.
- Has other danger signs.
- Refer to hospital urgently.
Antibiotics Used For Treatment
The Following Antibiotics can be Used:
CONTRIMOXAZOLE (Trimethoprim +
sulpha methaxazole)
- given 2 times daily for 5 days. (oral)
AMOXYCILLIN
- given 3 times a day for 5 days. (oral)
AMPICILLIN
- given 4 times a day for 5 days. (oral)
PROCAINE PENICILLIN
- given once a day for 5 days via
intra-muscular injection.
Treatment of Fever
(Temperature of at least 38 c)
- Tepid sponge
- Paracetamol
Treatment of Wheezing Child
First episode
- Give a fast acting bronchodilator-
Adrenaline
- If respiratory distress continues, give
Salbutamol
Asthma
- Give Adrenaline
- Assess after 30 minutes, if there is no
improvement
- Give Aminophylline intravenously
- Addition of a steroid is indicated where
the response to aminophylline is slow
Home Care (Advice to the Mother)
FEED THE CHILD
- Feed the child during the illness
- Increase feeding after the illness
- Clear the noses if they interfere with
feeding.
INCREASE THE FLUIDS
- Offer the child extra to drink
- Increase breast feeding
SOOTH THE THROAT AND RELIEVE
USING A SAFE REMEDY
TAKE THE CHILD BACK TO THE
HEALTH FACILITY IF:
- Breathing becomes difficult
- Breathing becomes fast
- Child is not able to drink
- Child becomes sicker.
NEXT ISSUE, WE FEATURE
TUBERCULOSIS IN ZAMBIA
FEATURE
HEALTHNET
Regina Cammy Shakakata is Medical librarian
at the University of Zambia and Healthnet
Liaison for Zambia. She is the Info-Med Project
Coordinator for Zambia, and her library serves
as the National Focal Point for the African Index
Medicus program.
Mission of HealthNet
The International Physician for the
Prevention of Nuclear War (IPPNW)
started a project called SatelLife in 1988.
It is a non-profit organisation whose
mission is to promote health
communication and information needs in
the developing world. SatelLife created
HealthNet, an inexpensive
telecommunications network by which
health care workers are communicating to
each other at home and abroad. The
technology used in this service is a low-
orbit micro satellite called HealthSat for
global communication and a terrestrial-
based electronic mail system for
intranational communication. HealthNet is
administered by SatelLife at global level,
with offices at Cambridge in the United
States of America and Moscow in Russia.
SatelLife is governed by an international
board of directors.
The primary focus of HealthNet is Africa
where the communication problems are
greatest. HealthNet ground stations are
installed in Cameroon at Yaounde, Congo
at Brazzaville, Ghana at Accra and at
Navrongo, Kenya at Nairobi,
Mozambique at Maputo, Tanzania at Dar
es Salaam, Uganda at Kampala, Zambia
at Lusaka, Zimbabwe at Harare, Brazil at
Rio de Janeiro, Cuba at Havana, Canada
at St. Johns, Australia at Tasmania, and
USA at Cambidge (headquarters). Other
ground stations are installed in Mali,
Malawi, Botswana, Ethiopia, Sudan and
the Gambia. South Africa will be the
next country to be hooked to HealthNet.
The world launching of HealthNet was
on 20th March, 1993. Zambia was chosen
as the worldwide launch site for the
project.
HealthNet in Zambia
HealthNet was adopted by the Workshop
of Hospital Administrators of October,
1993 as a communication project for
health care workers in Zambia. It aims at
improving communication among staff at
hospitals and health related organisations
in both rural and urban areas of the
country. The HealthNet points in Zambia
are installed in more than seventy-five
site in six of the nine provinces of
Zambia. The organisations which are
benefiting from HealthNet are the
Ministry of Health, University of Zambia
School of Medicine, University Teaching
Hospital, Tropical Diseases Research
Centre, Churches Medical Association of
Zambia, World Health Organisation
(WHO), the United Nations and its
agencies. Zambia Consolidated Copper
Mines (ZCCM), Chainama College of
Health Sciences, Medical Stores Limited.
The Carewell Pharmaceuticals, a non-
governmental and non-parastatal company
is using the service partially to circulate
its drug list.
There are some communication agents
namely the Zambia Flying Doctor
Service, Mission Medic Air and Flyspec
which are potential beneficiaries of
HealthNet and with which HealthNet
anticipates to form a liaison to offer a
better health communication service.
This electronic mail communication
service is made possible by using a
personal computer, modulator-
demodulator (modem) and a telephone
line. The computer software used to
communicate is fidonet where as the
frontdoor programme is jointly used with
fidonet to prepare short email messages.
Longer messages are prepared using
wordprocessing programmes such as
wordperfect or wordstar. Other data for
transmission by electronic mail is
prepared using appropriate programmes
and imported into frontdoor.
The Pilot Project
Bearing in mind that HealthNet is a new
project both at national and global levels,
the HealthNet Planning Committee
deemed it necessary to set it as a pilot
project in one of the provinces of the
country. The Southern Province of
Zambia was chosen as the site for the
pilot project because of its proximity to
Lusaka to enable regular monitoring of
the project and because a large number of
the postgraduate students are sent to the
hospitals in the province for attachments
of up to six months. The hospitals on the
pilot project are-: Kafue Gorge, Mtendere
in Chirundu, Siavonga, Chikankata,
Mazabuka, Monze, Gwembe,
Sinazongwe, Maamba, Choma, Macha,
Namwala, Kalomo, Zimba, Livingstone
General, Maramba Clinic and the office
of the Regional Health Advisor. Itezhi-
tezhi hospital is not on the pilot project
because it falls under Namwala District
Hospital.
In accordance to the objectives of the
pilot project, the HealthNet technician
visited twelve of the fifteen hospitals on
the pilot project, advising them to prepare
sites for the installation of HealthNet. All
the hospitals managed to secure or to
identify sufficiently secure rooms to host
HealthNet. The other site requirement is
the availability of an external telephone
line. All the hospitals have the necessary
requirements except Chikankata,
Sinazongwe, Macha and Namwala which
have telephone technical problems such
as using shared lines as in the case of
Chikankata, Zimba and Macha, or being
connected to out-dated equipment like
Namwala and Itezhi-Tezhi. Sinazongwe is
not connected to a telephone. Alternative
technologies were recommended for these
hospitals. Chikankata and Macha require
repeater transmitters and or radio
technology in order to have successful
HealthNet installations. Chikankata has
already acquired the technology and it
has been partially installed. Macha on the
other hand is still scouting for appropriate
technology. Namwala and Itezhi-Tezhi
need the involvement of the
Telecommunication Corporation (TC) to
install modern telecommunications
equipment at the Namwala Telephone
Exchange to replace the 1950 equipment
which is installed there. Sinazongwe
needs to either apply for a telephone line
from the PTC or acquire radio
technology.
The installation of HealthNet has been
done in the hospitals where all the
requirements are met. The computers that
are installed were provided by SatelLife.
The first brand of computers that was
installed is the Emason. This brand of
computers was not good enough for
telecommunication purposes, although
they worked well with non-
communication programmes. An NEC
brand of computers was brought in to
replace the Emason. The reconditioned
computers could not once more withstand
the pressure of being used for
communication purposes. One more time
the HealthNet Planning Committee sent
another request to SatelLife to provide
yet, another lot of computers. This
resulted in the installation of the AST
Advantage notebook in a number of the
HealthNet cites.
Hospitals like Chikankata and Macha
already have their own computers
installed, all they are waiting for is the
communication equipment to be installed.
Contrary to what was suggested when the
project was planned, the continuing
training programmes were not effected at
the time of data-collection partly due to
divided interest on the part of the full-
time HealthNet staff and partly due to
transport difficulties. The training which
is offered at the time of installing
HealthNet is too brief to sufficiently
equip HealthNet users who have never
been exposed to the necessary computer
skills to enable them to make maximum
use of the system. This training will be
to be enhanced when the project expands
to other provinces.
The isolation which the HealthNet users
suffered between the time of installation
and the time of data-collection was
evident in the anxiety expressed by the
HealthNet users during the visits of the
acting HealthNet staff towards the end of
1993 and in January and March 1994.
The visits of the acting HealthNet staff
brought in new life to the project and
revitalised the
users' interest which had suffered a great
deal from lack of working equipment and
contact with the HealthNet staff.
The full HealthNet report will be
available from the HealthNet Planning
Committee before the end of 1994. The
report is based on the pre-HealthNet
communication systems, the evaluation of
the impact of HealthNet in improved
patient care, health services and as a cost
saving measure in health communication.
Look for the Zambian Flying
Doctor Service in Next Issue's
Institutional Profile Section...
INSTITUTIONAL PROFILE
CHURCHES MEDICAL ASSOCIATION OF ZAMBIA.
Dr. Mazuba A. Banda is a coordinator of HIV/AIDS Prevention and
Control Activities in all mission hospitals
associated with the Churches Medical Association of Zambia.
Background
The Churches Medical Association of
Zambia (CMAZ) was created in 1970 as
an umbrella body of church
administration health institutions to
represent the interest of church
institutions.
CMAZ has in its membership over 86
Church Health institutions run by 17
different church denominations, both
Protestant and catholic. Altogether the
CMAZ member institutions are believed
to be responsible for over 50% of formal
health services in rural areas of Zambia
and about 30% of medical care in the
country as a whole.
Objectives
(a) To assist members develop the best
possible level of health care in Zambia
..
(b) To provide one proactive voice for
members in dialogue with Ministry of
Health, and other relevant authorities in
national policy formulation, negotiation,
soliciting and distribution of resources,
and representing Ministry of Health and
other relevant authorities requirements to
members.
(c) To provide and / or facilitate
managerial support, administrative
support, technical support and training for
members as required.
(d) To assist members develop training
programmes and coordinate government
recognized qualification training
programmes in cooperation with the
Ministry of Health and its statutory
bodies.
(e) To provide a forum for
communication and exchange of ideas,
information and experiences.
(f) To evaluate and monitor programmes
funded through CHAZ.
(g) To promote cooperation and
collaboration among members and with
Ministry of Health.
(h) To assist churches in formulating
appropriate policies and plans with regard
to health issues.
Functions
CMAZ provides a forum on which
church health institutions are able to take
united stand on matters of common
interest. Collaboration among church
health institutions and between them and
the government or other interested parties
has to a large extent enhanced through CMAZ.
CMAZ also provides other services to
member institutions. The services include
provisions of technical assistance in the
development of health programmes and
management of health institutions. CMAZ
mobilises funds for member institutions
to carry out general or specific health
programmes. CMAZ also assists members
in the procurement of drugs and other
medical supplies and recruitment of
personnel.
Programmes
There are a number of programmes going
on in church health institutions which are
centrally coordinated by CMAZ. These
include Primary Health Care, AIDS
Control Drugs procurement and
distribution.
Primary Health Care (PHC)
All member institutions are involved in
and committed to the achievement of
health for all through PHC. A
comprehensive, system of curative and
preventive activities both static and
mobile exists, Community Health
Workers (CHWs) and Traditional Birth
Attendants (TBAs) are being trained,
refresher courses and various seminars
for all cadres of staff involved in PHC
are conducted. A number of CHW's and
TBA's are working satisfactorily and
doing commendable work although they
face numerous difficulties.
HIV/AIDS Control
In 1986 CMAZ recognised AIDS a
major health problem in the country. In
response CMAZ evolved a multi faced
AIDS control programme which
incorporates home based care, health
education, blood screening, rehabilitation
and improvement of health facilities, and
training.
As a policy towards managing the present
situation regarding AIDS, CMAZ,
adopted the home based care support
system as a viable strategy. The basic
philosophy behind the home-based care
strategy is that AIDS problem is so
enormous and potentially catastrophic
that the only solution is for the families
and communities to be involved in the
problem themselves in terms of care and
prevention. It however rejects the concept
of building new hospitals institutions in
isolation to care for AIDS patients. In an
attempt to increase the awareness on
AIDS education programmes both for
specific group and the general public.
Pharmaceutical Services
CMAZ has for sometime now been
handling donations of drugs and medical
suppliers from various donors on behalf
of its members. CMAZ solicits for
donations of drugs, store and distributes
to all institutions on the basis of sizes and
work load of institutions. A nominal
handling fee is charged but certain drugs
such as T.B. vaccines are distributed free.
A small warehouse exists at CMAZ.
More shortage space is hired elsewhere in
Lusaka for the same purpose. Work is
already under way to construct a larger
warehouse at CMAZ which would better
meet the needs of the members. The
Drugs Committee has drawn up
guidelines on the use of essential drugs in
the member institutions.
Future Perspectives
The challenges for CMAZ in providing
adequate support to member institutions
continue to grow. Some areas that will
need to be developed and strengthened
include provision of training services in
various aspects of health care provision
and the development of an effective
information systems. The other
responsibilities that CMAZ currently
undertakes will need to be further
consolidated.
* Neither the Health Foundation nor the IBM
Corporation have any religious affiliation.
CURRENT NEWS FROM HEALTH RELATED SEMINARS AND WORKSHOPS
*AN IMPORTANT MESSAGE FROM THE HEALTH FOUNDATION, NEW YORK
Oct 18, 1994
Dear Health Worker,
The Health Foundation of New York (THF), in conjunction with the
Zambian Flying
Doctors Service (ZFDS) will be holding a Problem Solving for Better
Health (PSBH)
workshop in Ndola from February 3rd to 5th, 1995. Approximately 60
participants from
around Zambia will be invited to attend.
The aim of this workshop will be to assist participants in
devising solutions, in the
form of implementable and practical projects, to health problems
that they have identified
in their work and communities. Participants will be selected from
health workers from all
levels, provided their work involves primary health care and/or
front line contact with the
communities which they serve.
Anyone wishing to participate in the workshop should submit
a one page
summary indicating their level of training, current work and
location, as well as a list of
the top three health problems that they wish to find solutions to.
This summary must also
include ideas, which the participant already has, on how to solve
at least one of the
identified health problems. This information should reach the
undersigned no later than
December 9, 1994.
Participants will be expected to work hard, share with the
group, and implement
the protocols which they have produced, in their communities after
the workshop. We
look forward to receiving your submissions and to reading your
creative ideas for solving
health problems in your area.
Sincerely,
Dr. Mannasseh Phiri
THF Project Coordinator - Zambia
Address: (please use full address)
Dr. Mannasseh Phiri
ZFDS/THF - Digest
P.O. Box 71856
Ndola
Fax: (02) 614054
Email: mphiri@f1.n761.fidonet.org
Problem Solving for Better Health (PSBH)
All of us involved in the front line of health care are in a daily
struggle with health
problems of all sizes and levels of complexity. We know that to
better the health and save
the lives of the people we serve, we MUST find solutions to these
problems that are both
implementable and practical. Quite often, the solution is known
and already within our
reach; but we need just a little extra help to realize and
implement it. PSBH seeks to
encourage the new approaches and innovative ways of thinking which
assist health care
workers in solving their own community's problems.
THF's PSBH programme has been designed for front-line health
professionals who are
committed to achieving better health. The programme is a means of
training participants
to strengthen and develop both innate and acquired skills and to
empower them to take
action for better health. A handbook, developed by THF, augments
and emphasizes the
practical concepts of the programme. The participants are required
to devise and
implement creative solutions utilizing existing resources to solve
real health problems in
their communities and/or regions. They are also encouraged to work
together - to share
their ideas and experiences and to establish formal collaborative
networks which will last
and serve to support health care workers as they strive for better
health for more people.
Participants thus become teachers, making the effort catalytic and
self-sustaining.
The PSBH workshop in Zambia will serve as a platform on which
health workers will
share their problems with their colleagues and systematically work
together at developing
attainable, practical solutions. By the close of the workshop, the
goal is to have a
workable protocol for solving the health problem that each
participant brought with
him/her. PSBH has proven itself in 11 nations around the world,
including Ghana, India,
Jordan, El Salvador, and the United States. The workshop will
include a truly
international faculty of PSBH facilitators from around the world.
Over 277 'better health'
projects have been completed worldwide.
The mission of the Problem Solving for Better Health workshop is to
assist health care
workers in developing small scale problem solving projects to
provide better health for
more people in the communities which they serve. We will encourage
people to help
themselves identify and solve their own peoples' health problems
using, as much as
possible, available resources.
AUTHOR INDEX
Akbar, M.S. pg.
Akramuzzamen, S.M. pg.
Banda, M.A. pg.
Bezwoda, W.R. pg. x,y
Chintu, C. pg.
Cuevas, L.E. pg.
Dale, J. pg.
Degeus, A. pg.
Dollard, R.B pg.
Dupont, H.L. pg.
Eeckels, R. pg.
Gamatie, Y. pg.
Gordon, L. pg.
Grant, J.P. pg.
Halder, R. pg.
Hart, C.A. pg.
Himonga, H.B. pg.
Hughes, J.R. pg.
Huguet, D. pg.
Humbert, J. pg.
Jiang, Z.D. pg.
Katz, D.L. pg.
Khatum, M. pg.
Kuten, A. pg.
Kuvibidila, S. pg.
Lakier, R. pg. x,y
Luo, N. pg.
Macphail, P. pg. x,y
Malle, L.N. pg.
Marzouk, O. pg.
Mathewson, J.J. pg.
Mbewe, A.
Mewissen, J.H. pg
Ministry of Health. pg.
Mthombeni, G.T. pg.
Mukelabai K.
Mukiibi, J.M. pg.
Mukupo, F.C. pg.
Mutabingwa, J.K. pg.
Niebuhr, V.N. pg.
Paul, A. pg.
Pope, H.G. pg.
Praul, A. pg.
Redd, C. pg.
Roy, S.K. pg.
Ruff, P. pg.
Shakakata, R.C. pg
Sills, J. pg.
Spencer, D. pg, x,y
Stein, M.E. pg. x,y
Sunkutu, M.R. pg
Thomson, A.P. pg.
Trnobranski, P.H. pg.
Warrier, R.P. pg.
Wollo, J. pg.
Zumla, A. pg.
REQUEST FORM FOR FULL LENGTH TEXT OF ARTICLES
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today and we may even print them!)
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FOLLOWING ADDRESS:
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Medlib@zam.healthnet.org
Lusaka, Zambia
Medlib@p1.f1n761.z5.fidonet.org
Remember to apply for the
Problem Solving for Better
Health Workshop by
December 9!
*see preceding pages for more information