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Papers by kondwelani mateyo

PubMed, 2021

Congenital tracheobronchomegaly, also known as Mounier Kuhn Syndrome (MKS) is a rare respiratory ... more Congenital tracheobronchomegaly, also known as Mounier Kuhn Syndrome (MKS) is a rare respiratory disorder characterized by dilatation of the trachea and bronchi. We report a case of a 28-year-old male of African descent in Zambia, who presented with a history of chronic productive cough and repeated chest infections since childhood. He had been treated numerous times for lower respiratory tract infections, and had received empiric tuberculosis (TB) treatment based on chest radiograph findings, despite negative sputum microscopy and molecular tests for TB. Investigations revealed normal baseline blood results and sputum results. He however, had markedly increased levels of serum immunoglobulin E, and spirometry showed an obstructive pattern with significant post bronchodilator improvement. High-resolution computed tomography scan revealed tracheal dilatation, extensive bilateral bronchiectasis and tracheal and bronchial diverticula. The latter were also seen on bronchoscopy, confirming the diagnosis of Mounier-Kuhn syndrome. The patient was treated with combined inhaled corticosteroids and bronchodilators, as well as chest physiotherapy for mucus clearance, which led to improvement in his symptoms. Our case highlights how in low-resource settings, chronic lung diseases, particularly bronchiectasis, are often clinically and radiologically mistaken for and presumptively treated as TB (or its sequelae). Mounier-Kuhn syndrome, albeit rare, should be considered in the differential diagnosis of patients with recurrent lower respiratory tract infections or bronchiectasis. Multidisciplinary team meetings can help in the diagnosis of rare lung diseases.

BENTHAM SCIENCE PUBLISHERS eBooks, Mar 1, 2023

Medical Journal of Zambia

The implementation of interventions to minimize the Corona Virus 2019 (COVID-19) pandemic in Afri... more The implementation of interventions to minimize the Corona Virus 2019 (COVID-19) pandemic in Africa has been flurry and increasingly complicated in nature. This milieu engenders and heightens vulnerabilities of critical masses living in socially- compromised situations and economically constrained communities in the current pandemic. The increasing spread of COVID-19 has necessitated enforcement of frequent hand washing, social distancing and lockdown measures as a recommended global strategy to curb community-based spread of the disease. However, pre-existing conditions in Africa impede capacity to observe hand hygiene, social distancing and lockdown. Although past epidemics in Africa created foundations for planning for future occurrences, the enormity of the current COVID-19 pandemic has overwhelmed capacity to observe globally recommended interventions. The rising trends in morbidity and mortality has gained attention from community members, stakeholders, regulatory bodies and g...

Medical Journal of Zambia

An association of Vitamin D deficiency with Tuberculosis remains a valid assumption. It has been ... more An association of Vitamin D deficiency with Tuberculosis remains a valid assumption. It has been observed that TB is highly prevalent in certain ethnic groupings and regions of the world. Populations with darker skins are prone to vitamin D deficiency. The regions inhabited by people with darker skin coincides with high TB burden settings. Vitamin D has a key role in immune-modulation of the host response to Mycobacterium Tuberculosis infection. Studies have demonstrated early sputum culture conversion to negative, clinical recovery and radiological improvement with Vitamin D supplementation. However, there is currently no consens us on the advantages of this supplementation in TB treatment. We present the first case series report of pulmonary TB patients with severe deficiency of Vitamin D in Zambia. Additional data from randomised control studies is warranted.

BackgroundMen and women with undiagnosed tuberculosis (TB) in high burden countries may have diff... more BackgroundMen and women with undiagnosed tuberculosis (TB) in high burden countries may have differential factors influencing their healthcare seeking behaviors and access to TB services, which can result in delayed diagnoses and increase TB-related morbidity and mortality.MethodsA convergent, parallel, mixed-methods study design was used to explore and evaluate TB care engagement among adults (≥18 years) with newly diagnosed, microbiologically-confirmed TB attending three public health facilities in Lusaka, Zambia. Quantitative structured surveys characterized the TB care pathway (time to initial care-seeking, diagnosis, and treatment initiation) and collected information on factors influencing care engagement. Multinomial multivariable logistic regression was used to determine predicted probabilities of TB health-seeking behaviors and determinants of care engagement. Qualitative in-depth interviews (IDIs; n=20) were conducted and analyzed using a hybrid approach to identify barrie...

Medical journal of Zambia, 2014

JAMA Network Open

IMPORTANCE Delayed engagement in tuberculosis (TB) services is associated with ongoing transmissi... more IMPORTANCE Delayed engagement in tuberculosis (TB) services is associated with ongoing transmission and poor clinical outcomes. OBJECTIVE To assess whether patients with TB have differential preferences for strategies to improve the public health reach of TB diagnostic services. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study was undertaken in which a discrete choice experiment (DCE) was administered between September 18, 2019, and January 17, 2020, to 401 adults (>18 years of age) with microbiologically confirmed TB in Lusaka, Zambia. The DCE had 7 attributes with 2 to 3 levels per attribute related to TB service enhancements. Latent class analysis was used to identify segments of participants with unique preferences. Multiscenario simulations were used to estimate shares of preferences for different TB service improvement strategies. MAIN OUTCOMES AND MEASURES The main outcomes were patient preference archetypes and estimated shares of preferences for different strategies to improve TB diagnostic services. Collected data were analyzed between January 3, 2022, to July 2, 2022. RESULTS Among 326 adults with TB (median [IQR] age, 34 [27-42] years; 217 [66.8%] male; 158 [48.8%] HIV positive), 3 groups with distinct preferences for TB service improvements were identified. Group 1 (192 participants [58.9%]) preferred a facility that offered same-day TB test results, shorter wait times, and financial incentives for testing. Group 2 (83 participants [25.4%]) preferred a facility that provided same-day TB results, had greater privacy, and was closer to home. Group 3 (51 participants [15.6%]) had no strong preferences for service improvements and had negative preferences for receiving telephone-based TB test results. Groups 1 and 2 were more likely to report at least a 4-week delay in seeking health care for their current TB episode compared with group 3 (29 [51.3%] in group 1, 95 [35.8%] in group 2, and 10 [19.6%] in group 3; P < .001). Strategies to improve TB diagnostic services most preferred by all participants were same-day TB test results alone (shares of preference, 69.9%) and combined with a small financial testing incentive (shares of preference, 79.3%), shortened wait times (shares of preference, 76.1%), or greater privacy (shares of preference, 75.0%). However, the most preferred service improvement strategies differed substantially by group. CONCLUSIONS AND RELEVANCE In this study, patients with TB had heterogenous preferences for TB diagnostic service improvements associated with differential health care-seeking behavior. Tailored strategies that incorporate features most valued by persons with undiagnosed TB, including same-day results, financial incentives, and greater privacy, may optimize reach by overcoming key barriers to timely TB care engagement.

Clinical Infectious Diseases

Background Digital chest X-ray (dCXR) computer-aided detection (CAD) technology uses lung shape a... more Background Digital chest X-ray (dCXR) computer-aided detection (CAD) technology uses lung shape and texture analysis to determine the probability of tuberculosis (TB). However, many patients with previously treated TB have sequelae, which also distort lung shape and texture. We evaluated the diagnostic performance of 2 CAD systems for triage of active TB in patients with previously treated TB. Methods We conducted a retrospective analysis of data from a cross-sectional active TB case finding study. Participants ≥15 years, with ≥1 current TB symptom and complete data on history of previous TB, dCXR, and TB microbiological reference (Xpert MTB/RIF) were included. dCXRs were evaluated using CAD4TB (v.7.0) and qXR (v.3.0). We determined the diagnostic accuracy of both systems, overall and stratified by history of TB, using a single threshold for each system that achieved 90% sensitivity and maximized specificity in the overall population. Results Of 1884 participants, 452 (24.0%) had a ...

PLOS ONE

Background Community-acquired pneumonia (CAP) is a frequent cause of death worldwide, and in sub-... more Background Community-acquired pneumonia (CAP) is a frequent cause of death worldwide, and in sub-Saharan Africa particularly. Human immunodeficiency virus infection (HIV) and tuberculosis (TB) influence pathogen distribution in patients with CAP. Previous studies in sub-Saharan Africa have shown different frequencies of respiratory pathogens and antibiotic susceptibility compared to studies outside Africa. This study aimed to investigate the aetiology, presentation, and treatment outcomes of community-acquired pneumonia in adults at the University Teaching Hospital in Lusaka, Zambia. Materials and methods Three-hundred-and-twenty-seven patients were enrolled at the University Teaching Hospital in Lusaka between March 2018 and December 2018. Clinical characteristics and laboratory data were collected. Sputum samples were tested by microscopy, other TB diagnostics, and bacterial cultures. Results The commonest presenting complaint was cough (96%), followed by chest pain (60.6%), fever...

Medical journal of Zambia, 2019

Asthma is the most common paediatric chronic disease.1 In 2006, approximately 14 % of the world’s... more Asthma is the most common paediatric chronic disease.1 In 2006, approximately 14 % of the world’s children experienced asthma symptoms.2,3 In African countries, the prevalence of asthma ranges from approximately 10 % to more than 20%.2–4

In 1891, Winter1 described the first 4 cases of tuber-culous meningitis (TBM), in which “paracent... more In 1891, Winter1 described the first 4 cases of tuber-culous meningitis (TBM), in which “paracenteses of the theca vertebralis was performed to relieve cerebro-spinal fluid (CSF) fluid pressure. ” Since this original description of the lumbar puncture (LP) procedure, neurologists worldwide have relied on LPs for both diagnostic and therapeutic purposes. In resource-limited settings, LPs are often the only neurologic test available to aid the clinician in neurologic diagnosis. In sub-Saharan Africa, a large number of patients pre-sent to hospitals with acute neurologic symptoms, including those who are HIV-infected and have opportunistic infections such as cryptococcal menin-gitis and TBM. In these clinical scenarios, LPs are an essential point-of-care diagnostic and therapeutic pro-cedure.2 The benefits of the LP as a diagnostic tool are well-known, but it is important to emphasize that therapeutic LPs are a low-cost measure to monitor and treat intracranial pressure (ICP) due to no...

Objectives: To determine the aetiology of pulmonary disease in HAART-naive, HIV-infected Zambian ... more Objectives: To determine the aetiology of pulmonary disease in HAART-naive, HIV-infected Zambian adults with severe immunosuppression Design: A cross-section study. Setting: University Teaching Hospital, Lusaka, Zambia. Subjects: We conducted intensive TB screening for HAART-naive HIV-infected patients with CD4+ count less than 200/μL with pulmonary symptoms. Our algorithm comprised initial sputum screening with ZN stain. Patients unable to expectorate sputum and those in whom sputum smear for TB was negative underwent bronchoscopy. BAL was assessed for causative agents and correlated with clinical and radiological findings. Results: Of 113 enrolled patients, 43 (38.1%) had TB on initial sputum screen. 53 (46.9%) had sputum smears negative for TB and 17 (15.0%) were unable to expectorate sputum; of these, 58 (82.9%) agreed to further screening with bronchoscopy. 7 (12.1%) of the BAL specimens had TB on smear, while 14 (24.1%) had TB on culture alone. Cumulatively, 63 (55.8%) patient...

PLOS ONE, 2021

Objective To identify risk factors for delirium among hospitalized patients in Zambia. Methods We... more Objective To identify risk factors for delirium among hospitalized patients in Zambia. Methods We conducted a prospective cohort study at the University Teaching Hospital in Lusaka, Zambia, from October 2017 to April 2018. We report associations of exposures including sociodemographic and clinical factors with delirium over the first three days of hospital admission, assessed using a modified Brief Confusion Assessment Method (bCAM). Findings 749 patients were included for analysis (mean age, 42.9 years; 64.8% men; 47.3% with HIV). In individual regression analyses of potential delirium risk factors adjusted for age, sex and education, factors significantly associated with delirium included being divorced/widowed (OR 1.64, 95% CI 1.09–2.47), lowest tercile income (OR 1.58, 95% CI 1.04–2.40), informal employment (OR 1.97, 95% CI 1.25–3.15), untreated HIV infection (OR 2.18, 95% CI 1.21–4.06), unknown HIV status (OR 2.90, 95% CI 1.47–6.16), history of stroke (OR 2.70, 95% CI 1.15–7.19...

European Journal of Clinical Microbiology & Infectious Diseases, 2021

In the originally published article, the individual collaborator names were not captured under th... more In the originally published article, the individual collaborator names were not captured under the group name "GLIMP Collaborators". The names are now captured correctly under this group accordingly. The original article has been corrected.

PLOS ONE, 2021

Background Delays in the diagnosis of tuberculosis (TB) contribute to a substantial proportion of... more Background Delays in the diagnosis of tuberculosis (TB) contribute to a substantial proportion of TB-related mortality, especially among people living with HIV (PLHIV). We sought to characterize the diagnostic journey for HIV-positive and HIV-negative patients with a new TB diagnosis in Zambia, to understand drivers of delay, and characterize their preferences for service characteristics to inform improvements in TB services. Methods We assessed consecutive adults with newly microbiologically-confirmed TB at two public health treatment facilities in Lusaka, Zambia. We administered a survey to document critical intervals in the TB care pathway (time to initial care-seeking, diagnosis and treatment initiation), identify bottlenecks and their reasons. We quantified patient preferences for a range of characteristics of health services using a discrete choice experiment (DCE) that assessed 7 attributes (distance, wait times, hours of operation, confidentiality, sex of provider, testing i...

European Journal of Clinical Microbiology & Infectious Diseases, 2020

An accurate knowledge of the epidemiology of community-acquired pneumonia (CAP) is key for select... more An accurate knowledge of the epidemiology of community-acquired pneumonia (CAP) is key for selecting appropriate antimicrobial treatments. Very few etiological studies assessed the appropriateness of empiric guideline recommendations at a multinational level. This study aims at the following: (i) describing the bacterial etiologic distribution of CAP and (ii) assessing the appropriateness of the empirical treatment recommendations by clinical practice guidelines (CPGs) for CAP in light of the bacterial pathogens diagnosed as causative agents of CAP. Secondary analysis of the GLIMP, a point-prevalence international study which enrolled adults hospitalized with CAP in 2015. The analysis was limited to immunocompetent patients tested for bacterial CAP agents within 24 h of admission. The CAP CPGs evaluated included the following: the 2007 and 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA), the European Respiratory Society (ERS), and selected country-specific CPGs. Among 2564 patients enrolled, 35.3% had an identifiable pathogen. Streptococcus pneumoniae (8.2%) was the most frequently identified pathogen, followed by Pseudomonas aeruginosa (4.1%) and Klebsiella pneumoniae (3.4%).

PLOS ONE, 2021

Objective To study the epidemiology and outcomes of delirium among hospitalized patients in Zambi... more Objective To study the epidemiology and outcomes of delirium among hospitalized patients in Zambia. Methods We conducted a prospective cohort study at the University Teaching Hospital in Lusaka, Zambia, from October 2017 to April 2018. The primary exposure was delirium duration over the initial 3 days of hospitalization, assessed daily using the Brief Confusion Assessment Method. The primary outcome was 6-month mortality. Secondary outcomes included 6-month disability, evaluated using the World Health Organization Disability Assessment Schedule 2.0. Findings 711 adults were included (median age, 39 years; 461 men; 459 medical, 252 surgical; 323 with HIV). Delirium prevalence was 48.5% (95% CI, 44.8%-52.3%). 6-month mortality was higher for delirious participants (44.6% [39.3%-50.1%]) versus non-delirious participants (20.0% [15.4%-25.2%]; P < .001). After adjusting for covariates, delirium duration independently predicted 6-month mortality and disability with a significant dose-r...

BMC Infectious Diseases, 2020

An amendment to this paper has been published and can be accessed via the original article.

Chest, 2021

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

PubMed, 2021

Congenital tracheobronchomegaly, also known as Mounier Kuhn Syndrome (MKS) is a rare respiratory ... more Congenital tracheobronchomegaly, also known as Mounier Kuhn Syndrome (MKS) is a rare respiratory disorder characterized by dilatation of the trachea and bronchi. We report a case of a 28-year-old male of African descent in Zambia, who presented with a history of chronic productive cough and repeated chest infections since childhood. He had been treated numerous times for lower respiratory tract infections, and had received empiric tuberculosis (TB) treatment based on chest radiograph findings, despite negative sputum microscopy and molecular tests for TB. Investigations revealed normal baseline blood results and sputum results. He however, had markedly increased levels of serum immunoglobulin E, and spirometry showed an obstructive pattern with significant post bronchodilator improvement. High-resolution computed tomography scan revealed tracheal dilatation, extensive bilateral bronchiectasis and tracheal and bronchial diverticula. The latter were also seen on bronchoscopy, confirming the diagnosis of Mounier-Kuhn syndrome. The patient was treated with combined inhaled corticosteroids and bronchodilators, as well as chest physiotherapy for mucus clearance, which led to improvement in his symptoms. Our case highlights how in low-resource settings, chronic lung diseases, particularly bronchiectasis, are often clinically and radiologically mistaken for and presumptively treated as TB (or its sequelae). Mounier-Kuhn syndrome, albeit rare, should be considered in the differential diagnosis of patients with recurrent lower respiratory tract infections or bronchiectasis. Multidisciplinary team meetings can help in the diagnosis of rare lung diseases.

BENTHAM SCIENCE PUBLISHERS eBooks, Mar 1, 2023

Medical Journal of Zambia

The implementation of interventions to minimize the Corona Virus 2019 (COVID-19) pandemic in Afri... more The implementation of interventions to minimize the Corona Virus 2019 (COVID-19) pandemic in Africa has been flurry and increasingly complicated in nature. This milieu engenders and heightens vulnerabilities of critical masses living in socially- compromised situations and economically constrained communities in the current pandemic. The increasing spread of COVID-19 has necessitated enforcement of frequent hand washing, social distancing and lockdown measures as a recommended global strategy to curb community-based spread of the disease. However, pre-existing conditions in Africa impede capacity to observe hand hygiene, social distancing and lockdown. Although past epidemics in Africa created foundations for planning for future occurrences, the enormity of the current COVID-19 pandemic has overwhelmed capacity to observe globally recommended interventions. The rising trends in morbidity and mortality has gained attention from community members, stakeholders, regulatory bodies and g...

Medical Journal of Zambia

An association of Vitamin D deficiency with Tuberculosis remains a valid assumption. It has been ... more An association of Vitamin D deficiency with Tuberculosis remains a valid assumption. It has been observed that TB is highly prevalent in certain ethnic groupings and regions of the world. Populations with darker skins are prone to vitamin D deficiency. The regions inhabited by people with darker skin coincides with high TB burden settings. Vitamin D has a key role in immune-modulation of the host response to Mycobacterium Tuberculosis infection. Studies have demonstrated early sputum culture conversion to negative, clinical recovery and radiological improvement with Vitamin D supplementation. However, there is currently no consens us on the advantages of this supplementation in TB treatment. We present the first case series report of pulmonary TB patients with severe deficiency of Vitamin D in Zambia. Additional data from randomised control studies is warranted.

BackgroundMen and women with undiagnosed tuberculosis (TB) in high burden countries may have diff... more BackgroundMen and women with undiagnosed tuberculosis (TB) in high burden countries may have differential factors influencing their healthcare seeking behaviors and access to TB services, which can result in delayed diagnoses and increase TB-related morbidity and mortality.MethodsA convergent, parallel, mixed-methods study design was used to explore and evaluate TB care engagement among adults (≥18 years) with newly diagnosed, microbiologically-confirmed TB attending three public health facilities in Lusaka, Zambia. Quantitative structured surveys characterized the TB care pathway (time to initial care-seeking, diagnosis, and treatment initiation) and collected information on factors influencing care engagement. Multinomial multivariable logistic regression was used to determine predicted probabilities of TB health-seeking behaviors and determinants of care engagement. Qualitative in-depth interviews (IDIs; n=20) were conducted and analyzed using a hybrid approach to identify barrie...

Medical journal of Zambia, 2014

JAMA Network Open

IMPORTANCE Delayed engagement in tuberculosis (TB) services is associated with ongoing transmissi... more IMPORTANCE Delayed engagement in tuberculosis (TB) services is associated with ongoing transmission and poor clinical outcomes. OBJECTIVE To assess whether patients with TB have differential preferences for strategies to improve the public health reach of TB diagnostic services. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study was undertaken in which a discrete choice experiment (DCE) was administered between September 18, 2019, and January 17, 2020, to 401 adults (>18 years of age) with microbiologically confirmed TB in Lusaka, Zambia. The DCE had 7 attributes with 2 to 3 levels per attribute related to TB service enhancements. Latent class analysis was used to identify segments of participants with unique preferences. Multiscenario simulations were used to estimate shares of preferences for different TB service improvement strategies. MAIN OUTCOMES AND MEASURES The main outcomes were patient preference archetypes and estimated shares of preferences for different strategies to improve TB diagnostic services. Collected data were analyzed between January 3, 2022, to July 2, 2022. RESULTS Among 326 adults with TB (median [IQR] age, 34 [27-42] years; 217 [66.8%] male; 158 [48.8%] HIV positive), 3 groups with distinct preferences for TB service improvements were identified. Group 1 (192 participants [58.9%]) preferred a facility that offered same-day TB test results, shorter wait times, and financial incentives for testing. Group 2 (83 participants [25.4%]) preferred a facility that provided same-day TB results, had greater privacy, and was closer to home. Group 3 (51 participants [15.6%]) had no strong preferences for service improvements and had negative preferences for receiving telephone-based TB test results. Groups 1 and 2 were more likely to report at least a 4-week delay in seeking health care for their current TB episode compared with group 3 (29 [51.3%] in group 1, 95 [35.8%] in group 2, and 10 [19.6%] in group 3; P < .001). Strategies to improve TB diagnostic services most preferred by all participants were same-day TB test results alone (shares of preference, 69.9%) and combined with a small financial testing incentive (shares of preference, 79.3%), shortened wait times (shares of preference, 76.1%), or greater privacy (shares of preference, 75.0%). However, the most preferred service improvement strategies differed substantially by group. CONCLUSIONS AND RELEVANCE In this study, patients with TB had heterogenous preferences for TB diagnostic service improvements associated with differential health care-seeking behavior. Tailored strategies that incorporate features most valued by persons with undiagnosed TB, including same-day results, financial incentives, and greater privacy, may optimize reach by overcoming key barriers to timely TB care engagement.

Clinical Infectious Diseases

Background Digital chest X-ray (dCXR) computer-aided detection (CAD) technology uses lung shape a... more Background Digital chest X-ray (dCXR) computer-aided detection (CAD) technology uses lung shape and texture analysis to determine the probability of tuberculosis (TB). However, many patients with previously treated TB have sequelae, which also distort lung shape and texture. We evaluated the diagnostic performance of 2 CAD systems for triage of active TB in patients with previously treated TB. Methods We conducted a retrospective analysis of data from a cross-sectional active TB case finding study. Participants ≥15 years, with ≥1 current TB symptom and complete data on history of previous TB, dCXR, and TB microbiological reference (Xpert MTB/RIF) were included. dCXRs were evaluated using CAD4TB (v.7.0) and qXR (v.3.0). We determined the diagnostic accuracy of both systems, overall and stratified by history of TB, using a single threshold for each system that achieved 90% sensitivity and maximized specificity in the overall population. Results Of 1884 participants, 452 (24.0%) had a ...

PLOS ONE

Background Community-acquired pneumonia (CAP) is a frequent cause of death worldwide, and in sub-... more Background Community-acquired pneumonia (CAP) is a frequent cause of death worldwide, and in sub-Saharan Africa particularly. Human immunodeficiency virus infection (HIV) and tuberculosis (TB) influence pathogen distribution in patients with CAP. Previous studies in sub-Saharan Africa have shown different frequencies of respiratory pathogens and antibiotic susceptibility compared to studies outside Africa. This study aimed to investigate the aetiology, presentation, and treatment outcomes of community-acquired pneumonia in adults at the University Teaching Hospital in Lusaka, Zambia. Materials and methods Three-hundred-and-twenty-seven patients were enrolled at the University Teaching Hospital in Lusaka between March 2018 and December 2018. Clinical characteristics and laboratory data were collected. Sputum samples were tested by microscopy, other TB diagnostics, and bacterial cultures. Results The commonest presenting complaint was cough (96%), followed by chest pain (60.6%), fever...

Medical journal of Zambia, 2019

Asthma is the most common paediatric chronic disease.1 In 2006, approximately 14 % of the world’s... more Asthma is the most common paediatric chronic disease.1 In 2006, approximately 14 % of the world’s children experienced asthma symptoms.2,3 In African countries, the prevalence of asthma ranges from approximately 10 % to more than 20%.2–4

In 1891, Winter1 described the first 4 cases of tuber-culous meningitis (TBM), in which “paracent... more In 1891, Winter1 described the first 4 cases of tuber-culous meningitis (TBM), in which “paracenteses of the theca vertebralis was performed to relieve cerebro-spinal fluid (CSF) fluid pressure. ” Since this original description of the lumbar puncture (LP) procedure, neurologists worldwide have relied on LPs for both diagnostic and therapeutic purposes. In resource-limited settings, LPs are often the only neurologic test available to aid the clinician in neurologic diagnosis. In sub-Saharan Africa, a large number of patients pre-sent to hospitals with acute neurologic symptoms, including those who are HIV-infected and have opportunistic infections such as cryptococcal menin-gitis and TBM. In these clinical scenarios, LPs are an essential point-of-care diagnostic and therapeutic pro-cedure.2 The benefits of the LP as a diagnostic tool are well-known, but it is important to emphasize that therapeutic LPs are a low-cost measure to monitor and treat intracranial pressure (ICP) due to no...

Objectives: To determine the aetiology of pulmonary disease in HAART-naive, HIV-infected Zambian ... more Objectives: To determine the aetiology of pulmonary disease in HAART-naive, HIV-infected Zambian adults with severe immunosuppression Design: A cross-section study. Setting: University Teaching Hospital, Lusaka, Zambia. Subjects: We conducted intensive TB screening for HAART-naive HIV-infected patients with CD4+ count less than 200/μL with pulmonary symptoms. Our algorithm comprised initial sputum screening with ZN stain. Patients unable to expectorate sputum and those in whom sputum smear for TB was negative underwent bronchoscopy. BAL was assessed for causative agents and correlated with clinical and radiological findings. Results: Of 113 enrolled patients, 43 (38.1%) had TB on initial sputum screen. 53 (46.9%) had sputum smears negative for TB and 17 (15.0%) were unable to expectorate sputum; of these, 58 (82.9%) agreed to further screening with bronchoscopy. 7 (12.1%) of the BAL specimens had TB on smear, while 14 (24.1%) had TB on culture alone. Cumulatively, 63 (55.8%) patient...

PLOS ONE, 2021

Objective To identify risk factors for delirium among hospitalized patients in Zambia. Methods We... more Objective To identify risk factors for delirium among hospitalized patients in Zambia. Methods We conducted a prospective cohort study at the University Teaching Hospital in Lusaka, Zambia, from October 2017 to April 2018. We report associations of exposures including sociodemographic and clinical factors with delirium over the first three days of hospital admission, assessed using a modified Brief Confusion Assessment Method (bCAM). Findings 749 patients were included for analysis (mean age, 42.9 years; 64.8% men; 47.3% with HIV). In individual regression analyses of potential delirium risk factors adjusted for age, sex and education, factors significantly associated with delirium included being divorced/widowed (OR 1.64, 95% CI 1.09–2.47), lowest tercile income (OR 1.58, 95% CI 1.04–2.40), informal employment (OR 1.97, 95% CI 1.25–3.15), untreated HIV infection (OR 2.18, 95% CI 1.21–4.06), unknown HIV status (OR 2.90, 95% CI 1.47–6.16), history of stroke (OR 2.70, 95% CI 1.15–7.19...

European Journal of Clinical Microbiology & Infectious Diseases, 2021

In the originally published article, the individual collaborator names were not captured under th... more In the originally published article, the individual collaborator names were not captured under the group name "GLIMP Collaborators". The names are now captured correctly under this group accordingly. The original article has been corrected.

PLOS ONE, 2021

Background Delays in the diagnosis of tuberculosis (TB) contribute to a substantial proportion of... more Background Delays in the diagnosis of tuberculosis (TB) contribute to a substantial proportion of TB-related mortality, especially among people living with HIV (PLHIV). We sought to characterize the diagnostic journey for HIV-positive and HIV-negative patients with a new TB diagnosis in Zambia, to understand drivers of delay, and characterize their preferences for service characteristics to inform improvements in TB services. Methods We assessed consecutive adults with newly microbiologically-confirmed TB at two public health treatment facilities in Lusaka, Zambia. We administered a survey to document critical intervals in the TB care pathway (time to initial care-seeking, diagnosis and treatment initiation), identify bottlenecks and their reasons. We quantified patient preferences for a range of characteristics of health services using a discrete choice experiment (DCE) that assessed 7 attributes (distance, wait times, hours of operation, confidentiality, sex of provider, testing i...

European Journal of Clinical Microbiology & Infectious Diseases, 2020

An accurate knowledge of the epidemiology of community-acquired pneumonia (CAP) is key for select... more An accurate knowledge of the epidemiology of community-acquired pneumonia (CAP) is key for selecting appropriate antimicrobial treatments. Very few etiological studies assessed the appropriateness of empiric guideline recommendations at a multinational level. This study aims at the following: (i) describing the bacterial etiologic distribution of CAP and (ii) assessing the appropriateness of the empirical treatment recommendations by clinical practice guidelines (CPGs) for CAP in light of the bacterial pathogens diagnosed as causative agents of CAP. Secondary analysis of the GLIMP, a point-prevalence international study which enrolled adults hospitalized with CAP in 2015. The analysis was limited to immunocompetent patients tested for bacterial CAP agents within 24 h of admission. The CAP CPGs evaluated included the following: the 2007 and 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA), the European Respiratory Society (ERS), and selected country-specific CPGs. Among 2564 patients enrolled, 35.3% had an identifiable pathogen. Streptococcus pneumoniae (8.2%) was the most frequently identified pathogen, followed by Pseudomonas aeruginosa (4.1%) and Klebsiella pneumoniae (3.4%).

PLOS ONE, 2021

Objective To study the epidemiology and outcomes of delirium among hospitalized patients in Zambi... more Objective To study the epidemiology and outcomes of delirium among hospitalized patients in Zambia. Methods We conducted a prospective cohort study at the University Teaching Hospital in Lusaka, Zambia, from October 2017 to April 2018. The primary exposure was delirium duration over the initial 3 days of hospitalization, assessed daily using the Brief Confusion Assessment Method. The primary outcome was 6-month mortality. Secondary outcomes included 6-month disability, evaluated using the World Health Organization Disability Assessment Schedule 2.0. Findings 711 adults were included (median age, 39 years; 461 men; 459 medical, 252 surgical; 323 with HIV). Delirium prevalence was 48.5% (95% CI, 44.8%-52.3%). 6-month mortality was higher for delirious participants (44.6% [39.3%-50.1%]) versus non-delirious participants (20.0% [15.4%-25.2%]; P < .001). After adjusting for covariates, delirium duration independently predicted 6-month mortality and disability with a significant dose-r...

BMC Infectious Diseases, 2020

An amendment to this paper has been published and can be accessed via the original article.

Chest, 2021

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.