Mzaza Nthele | Cavendish University Zambia (original) (raw)

Papers by Mzaza Nthele

World Journal of Surgery, Oct 29, 2010

Background Trained health-care personnel are essential for improved outcomes for injured and crit... more Background Trained health-care personnel are essential for improved outcomes for injured and critically ill patients. The highest injury-related mortality is seen in sub-Saharan Africa, where there is a paucity of skilled personnel. Therefore, the College of Surgeons of East, Central, and Southern Africa (COSECSA) along with Emory University provided an acute trauma care (ATC) and fundamental critical care support course (FCCS). This study evaluates the impact of American-derived courses on the knowledge and confidence of participants from resource-limited countries. Methods Courses were held in Lusaka, Zambia, and Nakuru, Kenya. Participants were COSECSA trainees and personnel from local institutions. The evaluation used a pre-/postcourse multiple-choice exam for knowledge acquisition and a pre-/postcourse questionnaire for confidence assessment. Confidence was measured using a 5-point Likert score, with 5 being the highest level of confidence. Confidence or self-reported efficacy is correlated with increased performance of new skills. Results There were 75 participants (median age = 31 years, 67% male). Three-quarters of the participants reported no prior specific training in either trauma or critical care. Knowledge increased from an average of 51 to 63.3% (p = 0.002) overall, with a 21.7% gain for those who scored in the lowest quartile. Confidence increased from pre-to postcourse on all measures tested: 22 clinical situations (10 trauma, 9 critical care, 3 either) and 15 procedures (p \ 0.001 for all measures both individually and aggregated, Wilcoxon rank sum test). The strongest absolute increase in confidence, as well as the largest number of participants who reported any increase, were all in the procedures of cricothyroidotomy [median: pre = 3 (IQR: 2-3) to post = 5 (IQR: 4-5)], DPL [median: pre = 3 (IQR: 2-4) to post = 5 (IQR: 4-5)], and needle decompression [median: pre = 3 (IQR: 3-4) to post = 5 (IQR: 5-5)]. Conclusions Participants from resource-limited countries benefit from ATC/FCCS courses as demonstrated by increased knowledge and confidence across all topics presented. However, the strongest increase in confidence was in performing life-saving procedures. Therefore, future courses should emphasize essential procedures, reduce didactics, and link knowledge acquisition to skill-based teaching.

East and Central African Journal of Surgery, Dec 31, 2004

East and Central African Journal of Surgery, 2015

Background: Cholangiocarcinomas are primary malignant tumours developing from the epithelia of th... more Background: Cholangiocarcinomas are primary malignant tumours developing from the epithelia of the biliary ducts from the liver to the end of the bile duct in the duodenum. The objective of this review was to share our experience of seven well documented with this condition out of eleven observations treated at the Lusaka University Teaching Hospital (UTH) and point out the impact of palliative surgery played to provide comfortable quality survival. Methods: This was a ten-year retrospective study all patients operated on at the Lusaka University Teaching Hospital with confirmed diagnostic of cholangiocarcinoma. Seven well documented cases out of eleven treated were considered for this study. Results: Of the seven patients diagnosed with cholangiocarcinoma, four were males and three were females with ages ranging from 57 to 68 years and mean age of 64 years. At the time of admission, painless obstructive jaundice, with loss of appetite and loss of weight were recorded in 5 of the 7 ...

BJS Open, 2019

Background: Emergency and essential surgical, obstetric and anaesthesia (SOA) care are now recogn... more Background: Emergency and essential surgical, obstetric and anaesthesia (SOA) care are now recognized components of universal health coverage, necessary for a functional health system. To improve surgical care at a national level, strategic planning addressing the six domains of a surgical system is needed. This paper details a process for development of a national surgical, obstetric and anaesthesia plan (NSOAP) based on the experiences of frontline providers, Ministry of Health officials, WHO leaders, and consultants. Methods: Development of a NSOAP involves eight key steps: Ministry support and ownership; situation analysis and baseline assessments; stakeholder engagement and priority setting; drafting and validation; monitoring and evaluation; costing; governance; and implementation. Drafting a NSOAP involves defining the current gaps in care, synthesizing and prioritizing solutions, and providing an implementation and monitoring plan with a projected cost for the six domains of a surgical system: infrastructure, service delivery, workforce, information management, finance and governance. Results: To date, four countries have completed NSOAPs and 23 more have committed to development. Lessons learned from these previous NSOAP processes are described in detail. Conclusion: There is global movement to address the burden of surgical disease, improving quality and access to SOA care. The development of a strategic plan to address gaps across the SOA system systematically is a critical first step to ensuring countrywide scale-up of surgical system-strengthening activities.

World journal of surgery, Jan 8, 2018

Worldwide, five billion people lack access to safe, affordable surgical, obstetric, and anaesthes... more Worldwide, five billion people lack access to safe, affordable surgical, obstetric, and anaesthesia (SOA) care when needed. In many countries, a growing commitment to SOA care is culminating in the development of national surgical, obstetric, and anaesthesia plans (NSOAPs) that are fully embedded in the National Health Strategic Plan. This manuscript highlights the content and outputs from a World Health Organization (WHO) lead workshop that supported country-led plans for improving SOA care as a component of health system strengthening. In March 2018, a group of 79 high-level global SOA stakeholders from 25 countries in the WHO AFRO and EMRO regions gathered in Dubai to provide technical and strategic guidance for the creation and expansion of NSOAPs. Drawing on the experience and expertise of represented countries that are at different stages of the NSOAP process, topics covered included (1) the global burden of surgical, obstetric, and anaesthetic conditions; (2) the key principl...

Health Policy and Planning, 2018

The lack of access to quality-assured surgery in rural parts of sub-Saharan Africa, where the num... more The lack of access to quality-assured surgery in rural parts of sub-Saharan Africa, where the numbers of trained health workers are often insufficient, presents challenges for national governments. The case for investing in scaling up surgical systems in low-resource settings is 3-fold: the potential beneficial impact on a large proportion of the global burden of disease; better access for rural populations who have the greatest unmet need; and the economic case. The economic losses from untreated surgical conditions far exceed any expenditure that would be required to scale up surgical care. We identified the resources used in delivering surgery at a rural district-level hospital and an urban based referral hospital in Zambia and calculated their cost through a combination of bottom-up costing and step-down accounting. Surgery performed at the referral hospital is ∼50% more expensive compared with the district hospital, mostly because of the higher cost of hospital stay. The low bed occupancy rates at the two hospitals suggest underutilization of the capacity, and/or missing elements of needed capacity, to conduct surgery. Nevertheless, our study confirms that scaling up district-level surgery makes sense, through bringing economies of scale, while acknowledging the need for more comprehensive assessments and costing of capacity constraints. We quantified the economies of scale under different scaling scenarios. If surgery at the district hospital was scaled up by 10, 20 or 50%, the total cost of surgery would increase proportionately less than that, i.e. by 6, 12 and 30%, respectively. If this were to lead to less demand for surgery at the referral hospital, say 10% less surgery, it would result in a reduction of 2.7% in the total cost. Although the health system as a whole would benefit, the referring hospitals would not derive the full economic benefit, unless Government increased resources for district-level surgery.

World Journal of Surgery, 2010

East and Central African Journal of Surgery, 2014

Background : The decision for colostomy reversal is usually not easy and often reflects patient’s... more Background : The decision for colostomy reversal is usually not easy and often reflects patient’s desire, fully analyzed and agreed by the surgeon. The unavailability of mechanical suturing devices considerably increases this challenge. This study was aimed at sharing our experience with manual colostomy reversals (MCR) techniques after wide colorectal resections (WCRR) as well as documenting related early outcomes and complications. Methods : This retrospective study was carried out between 1st January 2007 and 31st December 2009, at the Lusaka University Teaching Hospital and The Lubumbashi University Clinics. Data were collected from operating lists, clinical records of in-patients and out-patient clinic records. Only fully documented cases with consistent targeted parameters including demography, indication for the colostomy, colostomy type, reversal technique, complications, hospital stay and discharge were considered for statistically analyze. Results : A total of 124 colostom...