District specific correlates for hypertension in Kaoma and Kasama rural districts of Zambia.

INTRODUCTION: Hypertension a major risk factor for cardiovascular disease and is the most widely recognized modifiable risk factor for this disease. There is little information on the prevalence and risk factors for hypertension in Zambia, and in particular in rural areas of the country. In order to contribute to the existing global literature on hypertension, particularly in rural Zambia, this study was conducted to determine the prevalence of hypertension and its correlates in two rural districts of Zambia, namely Kaoma and Kasama. METHODS: A cross-sectional study using a modified World Health Organization (WHO) global non communicable diseases (NCD) surveillance initiative NCD-STEPwise approach was used. Proportions were compared using the Yates' corrected χ2 test, and a result yielding a p-value of less than 5% was considered significant. Bivariate and multivariate logistic regression analyses were conducted. Factors that were significantly associated with the outcome in bivariate analyses were considered in a multivariate logistic regression analysis using a backward variable selection method. Adjusted odds ratios (AOR) and their 95% confidence intervals (CI) were reported. RESULTS: In total, 895 participants from Kaoma and 1198 participants from Kasama took part in the surveys. Overall, 25.8% participants (27.5% male, 24.6% female; p=0.373) in Kaoma and 30.3% (31.3% male, 29.5% female; p=0.531) in Kasama were hypertensive. In Kaoma, age and BMI were independently associated with hypertension. Compared with participants aged 45 years or older, participants aged 25-34 years were 60% (AOR=0.40, 95% CI [0.21, 0.56]) less likely to be hypertensive. Participants with BMI <18.5 and 18.5-24.9 were 54% (AOR=0.46, 95% CI [0.30, 0.69]) and 31% (AOR=0.69, 95% CI [0.49, 0.98]) less likely to be hypertensive compared with participants with BMI ≥30. In Kasama, age, smoking and heart rate were significantly associated with hypertension in multivariate analysis. Participants 25-34 years were 49% (AOR=0.51, 95% CI [0.41, 0.65]) less likely to be hypertensive compared with participants 45 years or older. Compared with participants who were non-smokers, smokers were 21% (AOR=1.21, 95% CI [1.02, 1.45]) more likely to be hypertensive. Participants who had heart rate >90 beats/min were 59% (AOR=1.59, 95% CI [1.17, 2.16]) more likely to be hypertensive compared with participants who had heart rate 60-90 beats/min. CONCLUSIONS: The findings reveal that hypertension is prevalent among rural residents in Kaoma and Kasama, Zambia. The disease is highly associated with age, BMI, smoking and heart rate. Efficient preventive strategies are needed to halt the growing trend of non-communicable diseases through the control of risk factors highlighted in this study.

Changes in tuberculosis notifications and treatment delay in Zambia when introducing a digital X-ray service.

SETTING: In August 2009, a digital chest X-ray (CXR) machine was installed at a busy urban health centre in Lusaka, Zambia. OBJECTIVE: To describe the changes in tuberculosis (TB) notifications and treatment delay ≥7 days in Zambia after introducing a digital X-ray service. DESIGN: Operational retrospective research of TB notification, laboratory and CXR data for Q4 2008 (prior to digital CXR) compared to Q4 2009. RESULTS: Notifications for sputum smear-negative TB increased by 8.1%, from 370/527 (70.2%) in Q4 2008 to 425/544 (78.1%) in Q4 2009, despite a 6.7% decrease in sputum smear positivity in Q4 2009. TB treatment delay decreased from 75/412 (18.2%) in Q4 2008 to 52/394 (13.2%) in Q4 2009 (P = 0.05). CONCLUSION: In Q4 2009, sputum smear-negative TB notifications increased and treatment delay decreased. However, accurate diagnosis of TB is challenging in this setting, and misdiagnosis and overtreatment may occur. Moreover, other factors in addition to the introduction of the digital X-ray service could have contributed to these findings. Nonetheless, we found that the digital X-ray service had many advantages and that it may aid in more efficient TB diagnosis.

Isolation and characterization of a unique endo-beta-1,6-glucanase from the yeast Saccharomycopsis fibuligera NCYC 451.

A beta-glucanase enzyme has been described which has beta-1,6 activity but no beta-1,3 activity. It was isolated and purified from cell free extract and culture free medium of Saccharomycopsis fibuligera by a combination of techniques that included adsorption on DEAE-Sepharose and gel filtration through a Sephacryl S-300 column. The extracellular endo-beta-1,6-glucanase had similar physicochemical properties to those of the intracellular one. The intracellular enzyme behaved as an acidic protein with pI 3.95. It had an optimum pH of 5.5 and optimum temperature of 50 degrees C. The enzyme was specific for beta-1,6-glucosidic linkages by an endo-acting mechanism. The molecular weight of the intracellular enzyme was estimated at 51 kD from gel filtration compared with 43 kD for the extracellular enzyme.

Understanding lay perspectives: care options for STD treatment in Lusaka, Zambia.

Understanding lay persons' perceptions of STD care is critical in the design and implementation of appropriate health services. Using 20 unstructured group interviews, 10 focus group discussions and 4 STD case simulations in selected sub-populations in Lusaka, we investigated lay person perspectives of STD services. The study revealed a large diversity of care options for STD in the communities, including self-care, traditional healers, medicine sold in the markets and streets, injections administered in the compounds, private clinics, health centres and hospital. The factors identified as influencing care seeking behaviour are: lay referral mechanisms, social cost, availability of care options, economics, beliefs, stigma and quality of care as perceived by the users.

PIP: Lusaka's health system is comprised of 4 hospitals, 22 government urban health centers, 144 private for-profit clinics, and more than 1000 traditional healers and traditional birth attendants. The authors explored laypeople's perspectives of sexually transmitted disease (STD) care services using 20 unstructured group interviews, 10 focus group discussions, and 4 STD case simulations in selected subpopulations of the city. People of differing age and sex were sampled. A large diversity of care options for STD was found in the communities, including self-care, traditional healers, medicine sold in the markets and streets, and injections administered in the compounds, private clinics, health centers, and hospitals. Lay referral mechanisms, social cost, the availability of care options, economics, beliefs, stigma, and the quality of care as perceived by users influence care-seeking behavior in this population.