Evaluation of Namibia's antiretroviral therapy guidelines' recommendations for switching from first-line to second-line, using predictors of first-line treatment failure: an exploratory study.

OBJECTIVES: The objective of this study was to find out the extent to which the antiretroviral therapy (ART) switching guidelines were complied with and to assess whether immediate switching from first- to second-line ART would have been appropriate than attempting to comply with the guidelines. METHODS: A case-control study. Cases and controls were patients on second- and first-line ART, respectively. Regression analysis was used to identify factors that were associated with switching to second-line ART. Confidence level was 95% and significance at a p-value <0.05. RESULTS: 81 cases and 102 controls were included. VLs at six and 9 months were implemented for 8.2% and 2.7%, respectively. Switching predictors were poor adherence (adjusted Hazard Ratio [aHR] = 20.3 (p = 0.013); a first VL >1000 copies/ml (aHR = 20.2), <0.001); opportunistic infections (aHR = 12.9, p = 0.006); male gender (aHR = 5.2, p = 0.003); and lack of adherence counseling (aHR = 3.8 p = 0.024). CONCLUSION: AVL >1000 copies/ml was a predictor of switching. New local research is underway, with a large number of patients, to assess whether this finding applies to the dolutegravir-based regimens.

Assessing Adherence to Antihypertensive Therapy in Primary Health Care in Namibia: Findings and Implications.

INTRODUCTION: Namibia has the highest burden and incidence of hypertension in sub-Sahara Africa. Though non-adherence to antihypertensive therapy is an important cardiovascular risk factor, little is known about potential ways to improve adherence in Namibia following universal access. The objective of this study is to validate the Hill-Bone compliance scale and determine the level and predictors of adherence to antihypertensive treatment in primary health care settings in sub-urban townships of Windhoek, Namibia. METHODS: Reliability was determined by Cronbach's alpha. Principal component analysis (PCA) was used to assess construct validity. RESULTS: The PCA was consistent with the three constructs for 12 items, explaining 24.1, 16.7 and 10.8% of the variance. Cronbach's alpha was 0.695. None of the 120 patients had perfect adherence to antihypertensive therapy, and less than half had acceptable levels of adherence (≥ 80%). The mean adherence level was 76.7 ± 8.1%. Three quarters of patients ever missed their scheduled clinic appointment. Having a family support system (OR = 5.4, 95% CI 1.687-27.6, p = 0.045) and attendance of follow-up visits (OR = 3.1, 95% CI 1.1-8.7, p = 0.03) were significant predictors of adherence. Having HIV/AIDs did not lower adherence. CONCLUSIONS: The modified Namibian version of the Hill-Bone scale is reliable and valid for assessing adherence to antihypertensives in Namibia. There is sub-optimal adherence to antihypertensive therapy among primary health cares in Namibia. This needs standardized systems to strengthen adherence monitoring as well as investigation of other factors including transport to take full advantage of universal access.

Compliance to guidelines for the prescribing of antibiotics in acute infections at Namibia's national referral hospital: a pilot study and the implications.

BACKGROUND: Sub-optimal antibiotic prescribing remains a public health concern in Namibia. The objective was to determine the level and predictors of compliance to guidelines in the prescribing of antibiotics in acute infections at a national referral hospital in Namibia to improve future prescribing. METHODS: An analytical cross-sectional survey design. The clinical records of patients receiving care were reviewed. Prescribing practices were assessed using a self- administered questionnaire with reference to Namibia Standard Treatment Guidelines (NSTG). RESULTS: The majority of prescriptions (62%) complied with the NSTGs; however, lower than national targets (95%). Most prescriptions were empiric and prescribers typically made reference to the NSTG (58%). Diagnosed infections were principally respiratory infections (58%) and penicillins were the most used antibiotics. Good concurrence between signs and symptoms with the diagnosis indicated on the prescription - OR=5.2 (95% CI: 1.4, 19.2), a diagnosis of upper respiratory tract (p=0.001), oral-dental OR=0.1(95% CI: 0.03,0.3) and urogenital infections OR=0.3(95% CI: 0.1,0.95) and the prescribing of penicillins (p=0.001) or combination antibiotics and amphenicols were independent predictors of compliance to the NSTGs. The main behaviours associated with antibiotic prescribing were patient influences, clinical state, and access to guidelines. CONCLUSIONS: Compliance with NSTGs is suboptimal. Prescribing of combination antibiotics, penicillins and diagnosis of oral dental, genitourinary and ear, nose and throat infections were important predictors for NSTG compliance. There is a need to implement antibiotic indicators and stewardship programmes, and ensure access to NSTGs, to improve future antibiotic prescribing in Namibia.

Case report: cholera in a preterm neonate.

Falling standards of sanitation resulted in the first outbreak of cholera in Lusaka, Zambia, during the rainy season, February 1990. A total of 2166 cases were handled with 128 (5.9%) deaths. One hundred and eight (108) children, including one preterm neonate, were admitted to the University Teaching Hospital. The neonate went to the Neonatal Intensive Care Unit.

Guidelines for the control of malaria in Zambia with emphasis on curative and prophylactic aspects

Malaria is endemic in all of Zambia and is a leading cause of morbidity and mortality. It is the most common cause of hospital admissions for all age groups. During the period 1976-1986; there has been a four-fold increase in the number of hospital deaths due to malaria and more than doubling of new cases. The incidence (new cases per year per 1000 population) has steadly increased from 137.8 in 1978 to 287.9 in 1988. The hospital case fatality rate has sharply increased; more than doubling from 13.9 per 1000 in 1978 to 74.8 per 1000 1988. The figures are an underestimate of the true epidemiological picture of malaria in the country as they represent only reported cases from public health institutions excluding information from the private practitioners and people who self treat their malaria when they fall ill. Factors influencing these trends include increasing disease virulence; increase in chloroquine resistant strains; loss herd immunity and changes in community prophylaxis