Characteristics and Surgical Repair Outcomes of Obstetric Fistula Patients Managedata Teaching Hospital in Zambia: A Retrospective Cross-Sectional Study

BackgroundThe obstetric fistula is a chronic maternal morbidity of global public health concern. The condition is preventable and, in most cases, treatable. Surgicalrepairis themainstay of treatment with varying degrees of success. The aim of this study was to determine the characteristics, surgical outcomes and factors influencing surgical outcomes of women presenting with obstetric fistulas at a Teaching Hospital in Lusaka, Zambia. Methods: Aretrospective review of medical records for all women who underwent obstetric fistula repair surgeryat Women and Newborn Hospital from 2017 to 2019. Descriptive analysis was done. Fischer's exact test was used to measure association between surgical outcomes and variables in the model.: ResultsIn total,18 out of 29 records of patients who underwentfistularepairwereretrievedandanalyzed. Ages ranged from 15 to 47 years, mean age 29years.Overtwothirds(72.23%)weremultiparous, and over 3/4ths (77.8%) underwent caesarean section in the antecedent pregnancy. Success rate for fistula repair was 83%at 2 weeks post-operative.Study findings were inadequate to show a significant association between successful repair and factors in the model. Conclusion: Majority of women presenting with obstetric fistula were multiparous with a history of prolonged labour, delivery by caesarean section and poor birth outcomes. Success rate for obstetric fistula repair at Women and Newborn Hospital was 83% at 2weeks postoperative. Further studies are needed to assess long-term outcomes and factors influencing surgical outcomes.:

Rapid assessment of institutional research ethics capacity: a case study from Zambia / Evaluación rápida de la capacidad institucional de investigación ética: un estudio de caso en Zambia / Avaliação rápida da capacidade institucional de ética em pesquisa: um estudo de caso na Zâmbia

Abstract: Recently, there has been a remarkable increase in biomedical research being conducted in low and middle-income countries. This increase has brought attention to the need for high quality research ethics systems within these countries and a greater focus on research ethics training. Though most programs tend to concentrate on training individuals, less attention has focused on institutions as the target of such training. In this paper we demonstrate a rapid approach to evaluating institutional research capacity. The method adapts the Octagon Model, which evaluates institutional research ethics using eight domains: basic values and identity, organization of activities, implementation, relevance, proper skills, financing and administration, target groups, and working environment. The framework was applied to the University of Zambia in order to conduct a baseline assessment of university research ethics capacity. Internal and external assessments were conducted. The domains of working environment and proper skills scored highest, while relevance, target groups and identity scored lower. Consistent with previous work, a systems approach to evaluating institutional research development capacity can provide a rapid assessment of an institutional bioethics program. This case study reveals the strengths and weaknesses of the university's research ethics program and provides a framework for future capacity growth.

Resumen: Recientemente, ha habido un notable aumento en la investigación biomédica en países de ingresos bajos y medianos. Este aumento ha llamado la atención sobre la necesidad de sistemas éticos de investigación de alta calidad en estos países y un mayor enfoque en la formación en ética de la investigación. Aunque la mayoría de los programas tienden a concentrarse en la formación de los individuos, menos atención se ha centrado en las instituciones como objetivo de dicha formación. En este trabajo se demuestra un enfoque rápido para evaluar la capacidad de investigación institucional. El método adapta el modelo Octagon, que evalúa la ética institucional de la investigación utilizando ocho dominios: valores básicos e identidad, organización de actividades, implementación, relevancia, habilidades adecuadas, financiamiento y administración, grupos objetivo y ambiente de trabajo. El marco se aplicó a la Universidad de Zambia, con el fin de realizar una evaluación inicial de la capacidad de ética de la investigación universitaria. Se realizaron evaluaciones internas y externas. Los ámbitos del entorno de trabajo y de las competencias apropiadas obtuvieron el puntaje más alto, mientras que la relevancia, los grupos objetivo y la identidad obtuvieron calificaciones más bajas. De acuerdo con trabajos previos, un enfoque sistémico para evaluar la capacidad de desarrollo institucional de la investigación puede proporcionar una evaluación rápida de un programa institucional de bioética. Este estudio de caso revela las fortalezas y debilidades del programa de ética de la investigación de la universidad y proporciona un marco para el futuro crecimiento de la capacidad.

Resumo: Recentemente, tem havido um notável aumento na investigação biomédica em países de renda baixa e média. Este aumento tem chamado a atenção para a necessidade de sistemas éticos de pesquisa de alta qualidade nesses países e um maior foco na formação em ética em pesquisa. Embora a maioria dos programas tende a se concentrar na formação dos indivíduos, menos atenção centrou-se em instituições como objetivo dessa formação. Este trabalho demonstra uma aproximação rápida para avaliar a capacidade de pesquisa institucional. O método adapta o modelo Octagon, que avalia a ética institucional de pesquisa usando oito domínios: valores básicos e identidade, organização das atividades, implementação, pertinência, competências adequadas, financiamento e administração, os grupos-alvo e ambiente de trabalho. O quadro foi aplicado para a Universidade da Zâmbia, a fim de fazer uma primeira avaliação da capacidade de ética em pesquisa universitária. Foram realizadas avaliações internas e externas. Os campos do ambiente trabalho e competências adequadas, obtiveram a maior pontuação, enquanto a relevância, grupos-alvo e identidade obtiveram qualificações inferiores. De acordo com trabalhos anteriores, uma abordagem sistêmica para avaliar a capacidade dedesenvolvimento institucional de pesquisa pode fornecer uma avaliação rápida de um programa institucional de bioética. Este estudo de caso revela os pontos fortes e pontos fracos do programa de ética em pesquisa da Universidade e fornece uma estrutura para o crescimento futuro da capacidade.

A survey to assess the extent of public-private mix DOTS in the management of tuberculosis in Zambia

Background: Involving all relevant healthcare providers in tuberculosis (TB) management through public-private mix (PPM) approaches is a vital element in the World Health Organization's (WHO) Stop TB Strategy. The control of TB in Zambia is mainly done in the public health sector; despite the high overall incidence rates. Aim: We conducted a survey to determine the extent of private-sector capacity; participation; practices and adherence to national guidelines in the control of TB. Setting: This survey was done in the year 2012 in 157 facilities in three provinces of Zambia where approximately 85% of the country's private health facilities are found. Methods: We used a structured questionnaire to interview the heads of private health facilities to assess the participation of the private health sector in TB diagnosis; management and prevention activities. Results: Out of 157 facilities surveyed; 40.5% were from the Copperbelt; 4.4% from Central province and 55.1% from Lusaka province. Only 23.8% of the facilities were able to provide full diagnosis and management of TB patients. Although 47.4% of the facilities reported that they do notify their cases to the National TB control programme; the majority (62.7%) of these facilities did not show evidence of notifications. Conclusion: Our results show that the majority of the facilities that diagnose and manage TB in the private sector do not report their TB activities to the National TB Control Programme (NTP). There is a need for the NTP to improve collaboration with the private sector with respect to TB control activities and PPM for Directly Observed Treatment; Short Course (DOTS)