In-vitro potential of crude extracts of selected garden herbs for mastitis management in Zambia

Introduction: The advent of bovine mastitis associated antimicrobial resistance has necessitated development of alternative herbal remedies. In this study, we tested, in-vitro, the antimicrobial efficacy of three crude extracts: (1) aqueous, (2) ethanol and (3) ethyl acetate extracts of Zambian cultivated Aloe barbadensis Miller (Aloe vera) and Curcuma longa (Turmeric) and also made comparisons to synthetic anti-mastitis formulations. Methods: The active compounds of these herbs were obtained as crude extracts using water, ethanol and ethyl acetate as solvents. The test microbes comprised of ten standard controls including Escherichia coli and Pseudomonas aeruginosa and 84 field isolates (all gram positive bacteria) from clinical and subclinical mastitis milk samples from selected districts of the Southern Province of Zambia belonging to the genera Staphylococcus, Streptococcus, Bacillus and Lactobacillus. The agar dilution method was used to determine the antimicrobial activity by observing the sensitivity which was graded as sensitive, intermediate or resistant. Commercial synthetic anti-mastitis preparations served as positive controls and their sensitivity was compared to that of the herbal preparations. The Minimum Inhibitory Concentrations (MIC) of the herbal formulation was also determined using two-fold serial dilutions. Results: The agar dilution test results of the field isolates indicated 18.8% resistance, 25.3% intermediate and 56% sensitivity for the herbal extracts, while the synthetic anti-mastitis preparation averaged 16.8% resistance, 4.75% intermediate and 78.5% sensitivity. The gram negative controls tested were generally resistant. On average, the agar dilution trials revealed; 41.8% resistance, 13% intermediate and 45.3% sensitivity for the herbal formulation while the synthetic antimicrobials produced 23.5% resistance, 5.2% intermediate and 71.3% sensitivity. Mean MIC was 11.5mg/ml at the 5% serial dilution for the herbal extract compared to the Cephalexin (semi-synthetic antimicrobial) MIC for S. aureus at 0.5mg/L or 0.0005mg/ml. Conclusion: The herbs Aloe vera and Curcuma longa from Zambia showed antimicrobial efficacy on bovine mastitis causing microbes and may be used as a cheaper alternative to synthetic anti-mastitis preparations and as an aid to fight antimicrobial resistance to the benefit of the most affected and resource limited small-scale dairy farmers.

Identification of MHC Alleles Associated With Disease Resistance/Susceptibility In Smallholder Cattle In Zambia

Background: The occurrence of Major Histocompatibility complex (MHC) alleles associated with resistance to Mastitis, Bovine Leukaemia Virus (BLV), Theileriosis, Foot and Mouth Disease (FMD) and susceptibility Dermatophilosis in African cattle is ill defined. Methods: Here, we used manual annotation to screen for five MHC alleles previously known to be associated with resistance/susceptibility to these diseases from a database of alleles sequenced from 846 cattle in Zambia. Results: Overall, we found 28 (3.3%), 21 (2.6%), 55 (6.5%), and 15 (1.8%) animals with resistance alleles to Mastitis, BLV, Theileriosis, FMD and 39 (4.6%) animals with susceptibility alleles to Dermatophilosis, respectively. Conclusion: This study provides the first evidence of resistance/susceptibility alleles in smallholder cattle in Zambia and the data could aid strategies for breeding cattle with enhanced resistance to disease in endemic countries.

Vancomycin Resistance in Staphylococcus aureus and Enterococcus Species isolated at the University Teaching Hospitals, Lusaka, Zambia: Should We Be Worried?

Background: Staphylococcus aureus and Enterococcus species cause invasive infections such as bacteremia and infective endocarditis. Despite vancomycin being the drug of choice for drug-resistant infections caused by these species, few studies have been conducted to ascertain vancomycin resistance in the African setting. This is crucial given the rising resistance in these organisms. This study aimed to isolate S. aureus and Enterococcus species and determine their susceptibility to vancomycin and other antibiotics at the University Teaching Hospitals in Lusaka, Zambia. Methods: This was a cross-sectional study in which S. aureus and Enterococcus spp isolates from the skin, soft tissue and bloodstream infections were included. Standard microbiological and Kirby-Baur (disc diffusion and E-strips) methods were used to identify and determine the susceptibility of the organisms, respectively. Results: From 59 S. aureus isolates, 37 were from the skin and soft tissue and 22 from blood culture. Twenty-six (44.1%) of these were Methicillin-resistant S. aureus. Thirty-nine Enterococcus were isolated from blood cultures only. Of the S. aureus (16) and Enterococcus (14) isolates tested with vancomycin E-strips, none were vancomycin-resistant. However, 12.5% S. aureus and 14.3% Enterococcus showed intermediate vancomycin susceptibility. S. aureus were resistant to penicillin (93.2%), erythromycin (52.5%) and tetracycline (50.8%). Enterococcus showed resistance to penicillin (83%) and tetracycline (84.6%). Conclusions: There was no vancomycin resistance among S. aureus and Enterococcus, implying vancomycin is still a viable treatment option for invasive infections. Given the intermediate vancomycin susceptibility, treatment guided by minimum inhibitory concentration results, continued surveillance and prudent use are key.

Evaluation of Bacterial Contamination of Beef Carcasses in Namwala and Lusaka Districts of Zambia

Abattoirs have been purported to be ideal areas were possible microbial contamination of meat products is likely to occur. Food of animal origin, mainly beef, has been identified as a source of dietary protein for humans albeit it being a source of food-borne diseases including zoonoses. This study was carried out to evaluate bacterial contamination and the risk factors associated with contamination of beef carcasses during processing. A total of four abattoirs were sampled within three months with one in Namwala and three in Lusaka districts. A total of 314 beef carcass surface swabs were obtained from the neck region by swabbing the carcasses, immediately after evisceration and after washing. Results The results of mean total viable counts (TVC) of carcass contamination were enumerated as the mean log from 4.7 Log10 cfu/cm2 in an abattoir where Hazard Analysis and Critical Control Points (HACCP) was practiced to 5.8 Log10 cfu/cm2 without HACCP. Bivariate analysis showed a significant difference in carcass contamination when town abattoirs (Lusaka) were compared with rural ones (Namwala); χ2 = 43.87, P < 0.0001. Multiple logistic regression analysis identified poor hygiene practices, the absence of antemortem inspection, and lack of Hazard Analysis and Critical Control Points (HACCP) implementation as significant factors associated with carcass contamination. Conclusion A high microbial load as determined by the Total Viable Count is an indicator that beef is being produced under poor abattoir hygiene conditions. Therefore, beef carcasses with high bacterial loads are potential sources of foodborne pathogens leading to foodborne disease and hence there is need for advocating for good hygiene practices in the abattoirs.

Morphophysiological Responses of Common Bean (Phaseolus vulgaris L.) Genotypes to Water Stress

Yield of common bean (Phaseolus vulgaris L.) is highly constrained by water deficit especially when this occurs during the reproductive development. The purpose of the study was to determine the association of the morphophysiological traits with water stress and how this affects grain yield in common beans. A field experiment involving eight common bean genotypes and three water regimes (50 %, 75 %, and 100 % of crop evapotranspiration) was conducted at National Irrigation Research Station, Mazabuka district during the 2012 growing season. A Split plot design with four replications was used; with soil moisture regime (main plot) and the genotypes (subplot). Based on variation in water stress tolerances, 8 test genotypes - Gadra, KE 3, KE 4, ZM 4488, SER 76 SER 180, SER 89 and CAR-ZAR were used. Water stress treatments were imposed at pre-flowering stage and was discontinued after 43 days when the crop was in its late reproductive stage. Significant differences were found among genotypes for Chlorophyll a (Chl a), Chlorophyll b (Chl b), Total Chlorophyll, Relative water content, Grain yield, Number pods per, Seed weight, Seeds per pod and Days to 50 % flowering under the three water stress conditions. The grain yield in normally irrigated condition (2191.3 kg ha-1) was 60 % higher than in high water stress condition (866.2 kg ha-1), while in the low water stress condition (1078.3 kg ha-1), the reduction in grain yield was 50.8 %. There were significant genotype by environment showing that the genotypes behaved differently under the different growing conditions. Results suggested that Gadra, KE 4, ZM 4488, and SER 180 were water stress tolerant while the SER 89, CAR-ZAR, KE 3 and SER 76 were water stress sensitive genotypes. These results suggest that a selection method based on 100 SW, Chl a, Chl b, and NPP can be used in breeding for bean genotypes to water stress.

Socio- Psychological factors associated with child sexual abuse: A study of Lusaka Central Prison Child sexual abuse convicts

Objectives and Study Design: with the view of examining the socio-psychological factors associated with child sexual abuse among child sexual abuse convicts, a study was conducted in Lusaka, the capital city of Zambia at Lusaka Central Prison also commonly known as Chimbokaila prison between January 2015 - July 2017. The scientific objectives of this study were to identify the background characteristics of convicts who are in jail for child sexual offenses; to establish the psychological factors associated with child sexual abuse among convicts; to explore the social correlates associated with child sexual abuse among convicts; to explore the social correlates associated with child sexual abuse among convicts and to establish the relationship between experiences of convicts in prison and behavioural intensions with regards to child sexual re-offending. 30 male child sexual abuse convicts were assessed for personality disorders and were interviewed to realize some of the social factors that may be associated with child sexual abuse. Results: Results of the DSMI IV criteria checklist showed that 24 respondents did not have a personality disorder while 6 respondents had a personality disorder. From the Minnesota Multiphasic Personality inventory 4 (MMPI- IV) showed that 10 participants had a personality disorder, while 20 participants did not have a personality disorder. Results obtained from social correlates associated with child sexual abuse were: misleading physical appearances and substance misuse. With regards to marital status, there was no statistical relationship between child sexual abuse and marital status. It was also found that there is no statistical relationship between child sexual abuse and alcohol consumption. It was also found that the respondents who took alcohol before imprisonment were more than those that did not. Most child sexual perpetrators were not sexually abused as children, those who were sexually abused as children were very few Percent and frequency distribution of respondents by age group was; age group 25-30 recorded 3 the highest frequency of 36.7%, followed by age group of 20-25 with 23.3%. Percent and frequency distribution of the respondents by marital status; of the total respondents 40 percent (n=12) were single and 46.7 percent (n=14) were married, divorced participants and others had an equal share of percentage at 6.7 percent (n=2). Conclusions: Put together the results suggest that the majority of participants did not have a personality disorder, in regards to Psychological factors that may be associated with child sexual abuse. Whereas a lot of common themes (most participants abused alcohol before imprisonment, were physically abused and not sexually abused in their childhood) were realized for social factors that may be associated with child sexual abuse, However for background characteristics it was found that most child sexual abusers were within their mid-twenties and most of them were single with a primary level of education as the highest level of education obtained by most participants.

Anaesthetic Related Peri-Operative Complications During Caesarean Delivery at the University Teaching Hospital, Lusaka, Zambia

Background: Caesarean deliveries are increasingly performed at the University Teaching Hospital (UTH), Lusaka, with a 2012 audit report indicating a rate of 17.8%.The procedure is a major surgical intervention and results in higher morbidity than vaginal delivery. Part of this morbidity and mortality during caesarean delivery is that resulting from the anaesthesia relating to the surgery. However, information on the extent of anaesthetic related complications associated with caesarean deliveries in low resource settings such as at UTH is lacking. This study endeavored to explore this aspect. Objective: To determine the frequency of anaesthetic related perioperative complications during caesarean delivery at the UTH, Lusaka, Zambia Study Design: A prospective observational study documenting the anaesthetic related complications in women undergoing caesarean delivery at UTH. 246 consecutive parturients undergoing caesarean deliveries were enrolled in the study. Methodology: All women who presented for caesarean delivery at UTH in Lusaka, Zambia from January 12, 2014 to July 12, 2014 and met the inclusion criteria were recruited into the study. Information on the patient and her management was obtained from the patient’s medical records. Participants were followed up from the time they were taken into theatre, during the procedure until the time they left the recovery room post operatively, and any complication observed was documented. Hypotension, possible aspiration, failed intubation, conversion from spinal to general anaesthesia, severe hypoxemia and death were the main outcome measures. A descriptive analysis was performed. All significant variables were included in the final multivariable logistic model. All tests were set at 95% confidence interval (CI) and a P- value of <0.05 was considered statistically significant. Results: No mortality was recorded out of the 246 parturients enrolled for the study. The average age was 28 years.Thirty-four cases (13.8%) received general anaesthetic while 212 cases (86.2%) had spinal anaesthetic. Obstructed labour 79 cases (32.1%) and previous caesarean sections 68 cases (27.6%) were among the indications for caesarean deliveries. Perioperative complications recorded included, 172 cases (69.9%) of hypotension, 6 cases (11.1%) had failed intubation, 5cases (9.3%) possibly aspirated, 20 cases (9.4%) had failed spinal technique needing conversion to general anaesthetic, 6 cases (3.1%) had high spinal block. Severe hypoxemia intraoperatively and postoperatively was noted in 16 cases (6.5%) and 7 cases (2.8%) respectively. There were no statistically significant associations among the complications with age of parturients, ASA status, grade of anaesthetist, category of caesarean sections, indication for caesarean sections or gestational age. Conclusion: There are many anaesthetic related complications during caesarean sections occurring at UTH. Future studies are needed to solely look into factors contributing to each of the complication at UTH.

Factors Influencing Utilisation of Diagnostic Counselling and Testing for HIV among Tuberculosis Patients at Monze Mission Hospital, Zambia

Background: Tuberculosis (TB) and human immunodeficiency virus (HIV) constitute the main burden of infectious disease in resource-limited Countries6. Persons infected with HIV are particularly susceptible to tuberculosis, both from the reactivation of latent infection and from new infection with rapid progression to active disease8. An individual who is HIV-positive has 10 times increased risk of developing TB compared to an HIV-negative person the lifetime risk is 50% for an HIV-positive person and 5–10 percent for an HIV-negative9. Estimates by the World Health Organization (WHO) indicate that there are more than 9 million new active cases of TB and close to 2 million deaths per year and that 2.6 million new cases of HIV infection and 1.8 million AIDS-related deaths occur per year6. TB programmes have focused on TB case finding and treatment, with little attention to HIV/AIDS interventions. According to David, (2004) untreated HIV infection leads to increased susceptibility to infections including TB. Currently, global estimates show that about 42 million people are HIV infected and almost one third are also infected with TB (WHO, 2005). The dual epidemics of TB and HIV are particularly pervasive in Africa, where HIV has been the single most common factor contributing to the incidence of TB over the last 10 years. TB and HIV are also a growing concern in Asia, where TB accounts for 40 percent of AIDS deaths (WHO, 2005).Therefore, HIV testing is particularly important in TB because mortality among HIV-infected TB patients is reduced if ART are provided (WHO, 2007). Main objective: To explore factors influencing utilization of Diagnostic Counselling and Testing for HIV among TB patients. Design:.A hospital-based cross-sectional study was carried out to assess the utilization of Diagnostic Testing and Counselling for Human Immune Virus/Acquired Immune Deficiency among tuberculosis patients. Zambia. Research design: A non-experimental which is exploratory study design was used in this study. The study employed a quantitative approach because little is known about DCT utilization. Research setting: The study was undertaken at Monze Mission Hospital chest clinic as it was selected purposively because of the convenience and ease accessibility to the facilities. It was also chosen on the basis that it conducts TB programmes on a daily basis and records showed low utilization of DCT services for HIV among TB patients. Study population: Men and women aged between 18 and 49 years will be included in the study as the above age group may give consent to DCT (MOH/NAC, 2006). The study will require 226 patients to participate. Sample: The sample size was calculated using the Epi- info version 6.0 statistical. The sampling frame will comprise all TB patients visiting chest clinic at the time of the study and who meet the set criteria. The participants were selected using simple random sampling method. The sample size was calculated basing on Krejcie and Morgan's18 formula for calculating sample size of a finite population. The calculated sample size comprised 226 participants. Inclusion criteria: TB patients within Monze Hospital aged between 18 and 49 years. This group was appropriate because it is sexually active and at risk of contracting TB and HIV infection. Patients will include those who are not critically ill to avoid withdraw before the end of the study. In addition, patients who will consent to participate in the study will be enrolled in the study. Exclusion criteria: TB patients outside Monze catchment referred to the chest clinic will not be included in the study because they may withdraw from the study due to distance. Patients aged less than 18 or more than 49 years who are referred to the ART sites for DCT will also not participate in the study. They may not consent to participate as they may think they are young or old to be at risk of contracting TB and HIV infection. Patients who will not consent or volunteer to participate in the study will be freely left out. Data collection tools and technique: Data was collected using a questionnaire. A structured interview schedule was used to collect socio-demographic data, measured variables and entering results of all the participants under study. Pretest: The tool was pre-tested on TB patients at Chikuni Mission Hospital. This hospital was selected because it has similar characteristics as the actual research site. Validity and reliability: A semi-structured interview schedule was used to capture data on demographic characteristics and factors results. The interview schedule was developed based on the World Health Organization (WHO) stepwise survey (STEPS) instrument 22. The same instruments were used on all the patients to ensure reliability and validity. Statistical analyses were carried out using IBM® SPSS® Statistics for Windows Version 20.0 (IBM Corp. Armonk, NY, and USA). The frequencies and descriptive statistics of the variables were calculated. Ethical considerations: Ethical approval and permission was sought from ERESConverge Ethics Committee. Main outcome measures: Diagnostic Counselling and Testing utilization among tuberculosis was assessed to determine the level of uptake. An interview schedule was used to assess utilization and determine the relationships among the factors. Results: The level of knowledge and confidentiality were statistically associated with DCT.Overall (n=226), majority 150(66.3%) of the patients did not utilize diagnostic counselling and testing services while 76 (33.6%) utilized diagnostic counselling and testing. The odds ratio of confidentiality was OR 0.52-1.637 and P-value 0.050 while level of knowledge; OR was 0.719-45.785 and P-value was 0.048 and the variables were statistically significantly associated with Diagnostic Counselling and Testing. The study showed that the patients who did not utilize DCT had 47% decrease in the odds of achieving high level of knowledge and confidentiality were less than 0.05 and therefore failed to reject the null hypothesis. Multivariate binary logistic regression model predicted that confidentiality and knowledge were associated with DCT at p-value of 0.05. Conclusion: Diagnostic Counselling and Testing utilization were low in the study population. Level of knowledge and confidentiality were the factors found to be associated with diagnostic testing and counselling. The findings suggest the need for information, education and communication as patients lack information on the importance of tuberculosis patients taking up the test.

Neonatal Apgar Score Outcomes in Spinal Versus General Anaesthesia at the University Teaching Hospital (UTH), Lusaka.

Background: The knowledge gap was from the fact that the type of anaesthetic drug administered during caesarean section can have effects on neonatal outcome like low Apgar score with most hospitals in developed countries now using more modern inhalational anaesthetic agents with fewer or no cardio-respiratory depressant effects e.g. Isoflurane or Sevoflurane. However at UTH, halothane is still being used for maintenance of general anaesthesia despite well documented cardio-respiratory depressant effects with very limited research done on its effects on neonatal Apgar score. The Apgar score is a means of rapid evaluation of the physical condition of infants shortly after birth. Thus this study investigated the effects of general anaesthesia with halothane versus spinal anaesthesia on neonatal Apgar score. Objective and study design: With the view of determining the type of anaesthesia administered during caesarean section with the least effects on neonatal wellbeing shortly after birth, a prospective observational cohort study was conducted at the University Teaching Hospital between May 2015 and January 2016.The scientific objective was to determine the effects of general anaesthesia with halothane versus spinal anaesthesia on neonatal Apgar score. This study involved 70 neonates, 54 were born from mothers that had undergone caesarean section under spinal anaesthesia and 16 from mothers that had undergone general anaesthesia. The data was analysed using SPSS version 16.0. Inferential analysis was conducted using logistic regression. Results: 20 neonates out of 54 (37%) in the spinal anaesthetic group had an Apgar score less than 8 at 1 minute[Fig 1]. Out of the 16 neonates in the general anaesthesia group, 14 (87.5%) had Apgar score less than 8 at 1 minute[Fig 1]. One (1.9%) neonate had an Apgar score less than 8 at 5 minutes in the spinal anaesthesia group. While 4 (25%) neonates had Apgar score less than 8 in the GA group[Fig2] The logistic regression at 1 minute Showed that it is over 11 times more likely to get a low Apgar with a general anaesthetic as compared to a spinal anaesthetic (OR 11.9), [Table 3]. The Apgar score at 1 minute in the Spinal anaesthesia group was statistically significantly higher than the general anaesthesia group (p=0.002). The logistic regression at 5 minutes Showed that it is over 17 times more likely to get a low Apgar with a general anaesthetic as compared to a spinal anaesthetic (OR 17.7), [Table 4]. Further, the 5 minutes Apgar score in the spinal anaesthesia group was statistically significantly higher than the general anaesthesia group (p=0.014),[Table 4]. Conclusion: With the results pointing to the fact that there is significant difference in neonatal Apgar score outcomes in spinal versus general anaesthesia, the researcher therefore rejected the null hypothesis. It is therefore inferred that spinal anaesthesia method has better neonatal outcomes by Apgar score measure than general anaesthesia method.

Accuracy and Completeness of Medication Histories in Patients in Medical Admission Ward at the University Teaching Hospital

Background: Quality documentation of medication histories at the time of hospitaladmission with regard to accuracy and completeness is not documented at the University Teaching Hospital (UTH), in Zambia. The aim of our study was to assess the accuracy and completeness of medication histories obtained in patients upon hospital admission. Materials and Methods: We conducted a prospective cross-sectional study at the medical admission ward, University Teaching Hospital, over a period of 3months. Our study enrolled 322 patients admitted to this ward who were above 18 years of age and were able to communicate verbally, if not, were accompanied by a caregiver. Clinical records of these patients were screened to review allmedications the patient was taking and patients/caregivers were interviewed to obtain acomplete medication history. All information obtained from patients through interviews was compared with medications recorded in the patient’s clinical records at the time of admission to the hospital. The Statistical Package for Social Sciences(SPSS) version 22 was used for all statistical calculations. Results: Of 287 clinical records, 175 (61%) incidents of inaccurate medication histories at the time of admission were identified and that medication histories in clinical records of patients were incomplete or poorly documented. Conclusion: Our study shows that 61% of medication histories in patients at the time of admission to hospitals are inaccurate. Quality documentation of medication histories in clinical records at the time of hospital admission is poor.