Application of Interprofessional Education Model to University Pre-Licensure Health Students in the Management of Chronic Care Conditions in Zambia

Background:Thereisevidencethatmultidisciplinary healthcare teams can provide better quality of care and treatment outcomes compared to that delivered by individuals from a single health discipline. The project on which this article isbased applied the interprofessional education model to university pre-licensure health students in the management of chronic care conditions in Zambia. Methods:Four distinct but interrelated approaches, name ly desk review; module development workshops; review and validation of modules by experts; piloting and review of the training modules were employed. Results: Severalmodelsofinterprofessionaleducationcurrentlyinexistenceandusedsuccessfully by higher education institutions in other settings were identified. While several models of Interprofessional Education were identified, our project adapted the "didactic program, community-based experience, and interprofessional-simulation experience" models. To apply the models, modules of seven chronic care conditions were developed and piloted. The extent to which the module activities promoted interprofessional education were rated between 74 - 87% (agree or strongly agree) by the students. Conclusion: Three models of Interprofessional Education were identified and adapted in the project and seven modules were developed and administered to the students. The process was effective for putting forth an interprofessional training program at the undergraduate level, with the potential to improve quality of care for patients.

Pulmonary Function Impairment in Female Workers Exposed to Environments with Varied Ambient Air Pollution in the Central Business Area of Lusaka-Zambia.

Aims: To determine the lung function of cleaners exposed to particulate matter of aerodynamic diameter less than 2.5 micrometer (PM2.5) in the streets and offices in Lusaka, Zambia. Study Design: This was a cross sectional study between two groups. Place and Duration of Study: Lusaka city, central business area, between June and August 2014. Methodology: The study included women between 18-50 years of age who had been working as street or office cleaners for 6 months or more. Males and individuals in both groups who used to smoke or were currently smokers, as well as those with a history of respiratory related illnesses or had cardiopulmonary conditions were excluded from the study. The cleaners were interviewed to get information on socio-demographic characteristics and other information using a structured interview schedule. The participants’ lung volumes, forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and their ratio (FEV1/FVC) were measured using a MRI spirobank G spirometer. On the day of the interview, PM2.5 in their work environment was sampled using a personal aerosol monitor (SIDEPAK AM510). Results: Out of the 90 participants, 45 were street sweepers and 45 were office cleaners. More street sweepers had impaired lung function (FEV1/FVC) 15(75%) than office cleaners 5(25%) p=0.01. FEV1 was also significantly different among street sweepers 12(70.6%) and office cleaners 5(29.4%) p=0.05. PM2.5 measurements revealed significantly high levels of exposure among street sweepers (p=0.001). Participants with impaired lung function (p=.005) and those with reduced FEV1percent predicted were exposed to significantly high concentrations of PM2.5 (p=0.012). Conclusion: Exposure to high PM2.5 concentration is associated with pulmonary function impairment and reduced FEV1 % predicted among cleaners.

Clinical Factors Associated with Atrial Fibrillation in Congestive Heart Failure Patients Admitted to the University Teaching Hospital, Lusaka, Zambia.

Introduction: Atrial fibrillation (AF) and Congestive Heart failure (CHF) have emerged as major global epidemics. Each of these conditions predisposes to the other, and their concomitant presence has additive adverse effects. This study examined the clinical factors associated with AF in CHF patients admitted to the University Teaching Hospital (UTH), Lusaka, Zambia. Methods: This was a hospital-based cross-sectional study done in the admission wards of the UTH involving adult patients with the primary diagnosis of congestive heart failure. The data was collected from July 2014 to September 2014. A structured interview schedule was used to capture the socio-demographic and related historical data. Then all patients had a standard 12-lead ECG done on them to check for AF. Those participants with no AF on a standard 12-lead ECG had 24- hours ECG DR180+ Digital Recorder applied to try to pick-up paroxysmal AF. Finally all participants with AF were assessed for clinical factors (i.e. sex, age, BMI, smoking, excessive alcohol intake, hypertension, coronary artery disease, dilated cardiomyopathy, diabetes mellitus, and chronic lung disease). Pearson chi-square of independence of the data was used to analyze the data in SPSS® 20.0 to determine clinical factors of AF in CHF patients. Results: A total of 49 patients were included in the study and 13 (26.5%) of them had AF, 7 diagnosed by standard ECG and 6 diagnosed by holter ambulatory ECG monitoring. The prevalence of AF in CHF was found to be strongly associated with age 65 years and above, obesity, smoking, excessive alcohol intake, hypertension, dilated cardiomyopathy, diabetes mellitus and chronic lung disease. These findings suggest the need for clinicians to consider full scale use of ambulatory ECG monitors in all CHF patients with the above conditions.

Carotid-radial Pulse Wave form and Velocity in Normotensive and Hypertensive Pregnant Women at University Teaching Hospital (UTH), Lusaka, Zambia.

Background: Hypertensive disease in pregnancy continues to be one of the leading causes of maternal death. Pregnancy induced hypertension (PIH) is said to be accompanied by several cardiovascular pathophysiological changes including increases in arterial stiffness. Pulse wave velocity (PWV) is a method for measuring arterial stiffness. Both the pulse wave form and the velocity are said to change in PIH. However, studies documenting these characteristics of the pulse wave have mainly been in the Caucasian population. Aims and Objectives: To establish the characteristics of the carotid-radial (cr) pulse wave in normotensive (NTN) and hypertensive (HTN) pregnant black African women at the UTH in Lusaka, Zambia. Methodology: This cross-sectional study comprised of 26 systemically selected pregnant women between the ages 18-45 years old who met the criteria. A structured interview was used to collect socio demographic data. Anthropometric measurements were taken. After a 15 minute rest, peripheral systolic and diastolic blood pressures (BP) were measured. The PWV measurement involved applying non-invasive piezoelectric sensors on the skin over the carotid artery in the neck and the radial artery on the wrist (carotid-radial segment crPWV). Using IBM® SPSS® version 20.0 analyses were made using mann - whitney and spearman correlation tests. A 95% confidence interval (CI) and P-value of <0.05 were set. Quality recordings were obtained from the crPWV recording processes showing the wave forms and specific measurements were made. Results: The anthropometric measurements were comparable between the 2 groups. There were significant changes in the pulse wave forms. While the normotensive participants had the type C wave form, the type A wave form was recorded from hypertensive participants. The augmentation pressure (AP) in NTN was 4±5 mmHg while it was 9±8 mmHg in HTN, indicating an increase in pressure difference from the systolic shoulder to the peak of the pulse wave (p <0.05). There was also a significant increase in the augmentation index (Aix) (1±22% vs 16±23%) (p<0.05). The hypertensive pregnant women also had a significantly higher PWV (9±4 m/s vs 13±7 m/s) (p<0.05). Conclusion: Distinct differences were seen in the cr pulse wave forms and velocity between normotensive and hypertensive individuals with PIH indicating an increase in arterial stiffness. These findings suggest the presence of significant peripheral vascular changes that may underly the pathophysiology of PIH.