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Papers by Bellington Vwalika

Medical journal of Zambia, 2010

Medical journal of Zambia, Sep 12, 2016

Obstetrical & Gynecological Survey, Dec 1, 2020

Medical Journal of Zambia

Background: West Africa experienced the largest outbreak of Ebola in 2014 in history involving th... more Background: West Africa experienced the largest outbreak of Ebola in 2014 in history involving three Mano River States of Sierra Leone, Liberia and Guinea. The World Health Organization (WHO) coordinated an emergency response from WHO Country Offices in many areas, including human resources for health services. WHO Zambia deployed human resources (HR) focal persons to Sierra Leone and Liberia to strengthen operations. The purpose of this paper is to document the contributions made by WHO Zambia human resources staff that were deployed for more than six weeks during this outbreak and areas of value of this exposure experience.Methods: A review of standard operating procedures (SOPs) in an Ebola setting and experiences gained during the deployment of staff in Sierra Leone and Liberia were recorded systematically. Comparisons were made between experiences gained in the WHO offices situated in the Ebola outbreak setting and one outside such a setting. Lessons learned from this deploymen...

Medical Journal of Zambia

Background: Health system strengthening continues to be a moving target for developing countries ... more Background: Health system strengthening continues to be a moving target for developing countries with the human resource factor the most critical bottleneck towards universal health coverage.The human resource management cycle revolves around three interdependent factors: production, recruitment, deployment and retention. The most elusive is retention where both monetary and non-monetary reward systems are equally important. The purpose of this is to document establishment of e-learning as a tool for online skills transfer to address retention of health workers in a cost effectively.Methods: This prospective study analyses the process of establishing an e-learning facility in Central Province of Zambia. Visitations of the site in the PEPFAR (US President Emergency Plan for Aids Relief in Africa) sponsored Chainama College of Health Sciences, Kabwe Campus premises and technical inputs and specifications were documented.Results: The Ministry of Health maximized the prevailing thriving...

The Global Health Network Conference Proceedings 2022

Science Advances

Preterm birth (PTB) is the leading cause of death in children under five, yet comprehensive studi... more Preterm birth (PTB) is the leading cause of death in children under five, yet comprehensive studies are hindered by its multiple complex etiologies. Epidemiological associations between PTB and maternal characteristics have been previously described. This work used multiomic profiling and multivariate modeling to investigate the biological signatures of these characteristics. Maternal covariates were collected during pregnancy from 13,841 pregnant women across five sites. Plasma samples from 231 participants were analyzed to generate proteomic, metabolomic, and lipidomic datasets. Machine learning models showed robust performance for the prediction of PTB (AUROC = 0.70), time-to-delivery ( r = 0.65), maternal age ( r = 0.59), gravidity ( r = 0.56), and BMI ( r = 0.81). Time-to-delivery biological correlates included fetal-associated proteins (e.g., ALPP, AFP, and PGF) and immune proteins (e.g., PD-L1, CCL28, and LIFR). Maternal age negatively correlated with collagen COL9A1, gravidi...

Scientific Reports, Nov 17, 2022

Additional file 1. Focus group discussion guide example (women).

Additional file 2. Interview topic guide.

Additional file 2. A table describing the relationship between detectable viral load and angiogen... more Additional file 2. A table describing the relationship between detectable viral load and angiogenic biomarker concentration.

Additional file 1. A table comparing demographic variables between the overall ZAPPS cohort and t... more Additional file 1. A table comparing demographic variables between the overall ZAPPS cohort and this nested case-control study.

Additional file 2: Table 1. Country-specific comparison of characteristics of those with and with... more Additional file 2: Table 1. Country-specific comparison of characteristics of those with and without intrapartum transfer.

Additional file 1. SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protoc... more Additional file 1. SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents.

Table S1. Effect of the intervention on referrals in individual clusters. Table S2. Effect of the... more Table S1. Effect of the intervention on referrals in individual clusters. Table S2. Effect of the intervention on the primary outcome in individual clusters. Figure S1. Thresholds that trigger the traffic light early warning system on the CRADLE Vital Sign Alert (DOCX 6918 kb)

University of Zambia Journal of Agricultural and Biomedical Sciences, 2020

Background: The importance of regulating electrolyte levels is well recognized in most Intensive ... more Background: The importance of regulating electrolyte levels is well recognized in most Intensive Care Units (ICU). Various institutions across the globe have found varying figures on the extent and causes of electrolytes derangements in ICUs. The extent of electrolyte and fluid imbalance in patients being admitted and already admitted to the Main ICU (MICU) at the University Teaching Hospital (UTH) Lusaka Zambia is unknown. This study aimed to explore the 24hour changes in sodium and potassium in adult MICU patients at the UTH, Lusaka, Zambia. Methods: This was a prospective cohort study of the patients admitted to the MICU at UTH, Lusaka, Zambia. Data was collected over a four-month period (August to November) in 2017. Only consenting patients 18 years and above admitted for at least 24 hours in the unit were enrolled. On admission, routine baseline investigations were obtained from every patient which included a full blood count and renal function tests. The second set of investig...

PAMJ - One Health, 2021

INTRODUCTION: Sexual and gender-based violence (SGBV) is a global public health problem and women... more INTRODUCTION: Sexual and gender-based violence (SGBV) is a global public health problem and women are disproportionally affected. SGBV has an acute and chronic impact on health. We set out to apply autoregressive integrated moving average (ARIMA) models to make predictions on the number of SGBV cases reported to the Women and Newborn Hospital of the University Teaching Hospitals in Lusaka, Zambia. METHODS: we retrospectively collected monthly number of SGBV cases from April 2017 to December 2019 as a primary outcome measure. We utilized the following strategy for the analysis; we developed the Box-Jerkins methodology through identification, estimation and diagnostic checks before using the model for forecasting. Structural ARIMA models were used to model the number of SGBV cases. We considered the simplest parsimonious lowest order model based on the lowest volatility, highest log-likelihood value, most significant coefficients, and the lowest Akaike information criteria and Bayesian information criteria values. RESULTS: the ARIMA (1,1,1) model was able to forecast the number of SGBV cases. The forecasted mean monthly was 31.7 (95% CI: 29.9-33.3). The prediction error assessed by mean absolute percentage error was 10.3%, and the root mean standard error was 6.6. Further, a comparison of the observed and predicted values showed no statistically significant difference (p=0.753). CONCLUSION: the ARIMA model can be a useful tool for planners and clinicians to manage survivors of sexual and gender-based violence at the Women and newborn hospital.

The Lancet HIV, 2021

Summary Background Women with HIV face an increased risk of preterm birth. 17 alpha-hydroxyproges... more Summary Background Women with HIV face an increased risk of preterm birth. 17 alpha-hydroxyprogesterone caproate (17P) has been shown in some trials to reduce early delivery among women with a history of spontaneous preterm birth. We investigated whether 17P would reduce this risk among women with HIV. Methods We did a randomised, double-blind, placebo-controlled trial in pregnant women with HIV at the University Teaching Hospital and Kamwala District Health Centre in Lusaka, Zambia. Eligible patients were women aged 18 years or older with confirmed HIV-1 infection, viable intrauterine singleton pregnancy at less than 24 weeks of gestation, and were receiving or intending to commence antiretroviral therapy during pregnancy. Exclusion criteria were major uterine or fetal anomaly; planned or in situ cervical cerclage; evidence of threatened miscarriage, preterm labour, or ruptured membranes at screening; medical contraindication to 17P; previous participation in the trial; or history of spontaneous preterm birth. Eligible participants provided written informed consent and were randomly assigned (1:1) to receive 250 mg intramuscular 17P or placebo once per week, starting between 16 and 24 weeks of gestation until delivery, stillbirth, or reaching term (37 weeks). Participants and study staff were masked to assignment, except for pharmacy staff who did random assignment and prepared injections but did not interact with participants. The primary outcome was a composite of delivery before 37 weeks or stillbirth at any gestational age. Patients attended weekly visits for study drug injections and antenatal care. We estimated the absolute and relative difference in risk of the primary outcome and safety events between treatment groups by intention to treat. This trial is registered with ClinicalTrials.gov, NCT03297216, and is complete. Findings Between Feb 7, 2018 and Jan 13, 2020, we assessed 1042 women for inclusion into the study. 242 women were excluded after additional assessments, and 800 eligible patients were enrolled and randomly assigned to receive intramuscular 17P (n=399) or placebo (n=401). Baseline characteristics were similar between groups. Adherence to study drug injections was 98% in both groups, no patients were lost to follow-up, and the final post-partum visit was on Aug 6, 2020. 36 (9%) of 399 participants assigned to 17P had preterm birth or stillbirth, compared with 36 (9%) of 401 patients assigned to placebo (risk difference 0·1, 95% CI −3·9 to 4·0; relative risk 1·0, 95% CI 0·6 to 1·6; p=0·98). Intervention-related adverse events were reported by 140 (18%) of 800 participants and occurred in similar proportions in both randomisation groups. No serious adverse events were reported. Interpretation Although 17P seems to be safe and acceptable to participants, available data do not support the use of the drug to prevent preterm birth among women whose risk derives solely from HIV infection. The low risk of preterm birth in both randomisation groups warrants further investigation. Funding US National Institutes of Health and the Bill and Melinda Gates Foundation.

American Journal of Obstetrics and Gynecology, 2021

Medical journal of Zambia, 2010

Medical journal of Zambia, Sep 12, 2016

Obstetrical & Gynecological Survey, Dec 1, 2020

Medical Journal of Zambia

Background: West Africa experienced the largest outbreak of Ebola in 2014 in history involving th... more Background: West Africa experienced the largest outbreak of Ebola in 2014 in history involving three Mano River States of Sierra Leone, Liberia and Guinea. The World Health Organization (WHO) coordinated an emergency response from WHO Country Offices in many areas, including human resources for health services. WHO Zambia deployed human resources (HR) focal persons to Sierra Leone and Liberia to strengthen operations. The purpose of this paper is to document the contributions made by WHO Zambia human resources staff that were deployed for more than six weeks during this outbreak and areas of value of this exposure experience.Methods: A review of standard operating procedures (SOPs) in an Ebola setting and experiences gained during the deployment of staff in Sierra Leone and Liberia were recorded systematically. Comparisons were made between experiences gained in the WHO offices situated in the Ebola outbreak setting and one outside such a setting. Lessons learned from this deploymen...

Medical Journal of Zambia

Background: Health system strengthening continues to be a moving target for developing countries ... more Background: Health system strengthening continues to be a moving target for developing countries with the human resource factor the most critical bottleneck towards universal health coverage.The human resource management cycle revolves around three interdependent factors: production, recruitment, deployment and retention. The most elusive is retention where both monetary and non-monetary reward systems are equally important. The purpose of this is to document establishment of e-learning as a tool for online skills transfer to address retention of health workers in a cost effectively.Methods: This prospective study analyses the process of establishing an e-learning facility in Central Province of Zambia. Visitations of the site in the PEPFAR (US President Emergency Plan for Aids Relief in Africa) sponsored Chainama College of Health Sciences, Kabwe Campus premises and technical inputs and specifications were documented.Results: The Ministry of Health maximized the prevailing thriving...

The Global Health Network Conference Proceedings 2022

Science Advances

Preterm birth (PTB) is the leading cause of death in children under five, yet comprehensive studi... more Preterm birth (PTB) is the leading cause of death in children under five, yet comprehensive studies are hindered by its multiple complex etiologies. Epidemiological associations between PTB and maternal characteristics have been previously described. This work used multiomic profiling and multivariate modeling to investigate the biological signatures of these characteristics. Maternal covariates were collected during pregnancy from 13,841 pregnant women across five sites. Plasma samples from 231 participants were analyzed to generate proteomic, metabolomic, and lipidomic datasets. Machine learning models showed robust performance for the prediction of PTB (AUROC = 0.70), time-to-delivery ( r = 0.65), maternal age ( r = 0.59), gravidity ( r = 0.56), and BMI ( r = 0.81). Time-to-delivery biological correlates included fetal-associated proteins (e.g., ALPP, AFP, and PGF) and immune proteins (e.g., PD-L1, CCL28, and LIFR). Maternal age negatively correlated with collagen COL9A1, gravidi...

Scientific Reports, Nov 17, 2022

Additional file 1. Focus group discussion guide example (women).

Additional file 2. Interview topic guide.

Additional file 2. A table describing the relationship between detectable viral load and angiogen... more Additional file 2. A table describing the relationship between detectable viral load and angiogenic biomarker concentration.

Additional file 1. A table comparing demographic variables between the overall ZAPPS cohort and t... more Additional file 1. A table comparing demographic variables between the overall ZAPPS cohort and this nested case-control study.

Additional file 2: Table 1. Country-specific comparison of characteristics of those with and with... more Additional file 2: Table 1. Country-specific comparison of characteristics of those with and without intrapartum transfer.

Additional file 1. SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protoc... more Additional file 1. SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents.

Table S1. Effect of the intervention on referrals in individual clusters. Table S2. Effect of the... more Table S1. Effect of the intervention on referrals in individual clusters. Table S2. Effect of the intervention on the primary outcome in individual clusters. Figure S1. Thresholds that trigger the traffic light early warning system on the CRADLE Vital Sign Alert (DOCX 6918 kb)

University of Zambia Journal of Agricultural and Biomedical Sciences, 2020

Background: The importance of regulating electrolyte levels is well recognized in most Intensive ... more Background: The importance of regulating electrolyte levels is well recognized in most Intensive Care Units (ICU). Various institutions across the globe have found varying figures on the extent and causes of electrolytes derangements in ICUs. The extent of electrolyte and fluid imbalance in patients being admitted and already admitted to the Main ICU (MICU) at the University Teaching Hospital (UTH) Lusaka Zambia is unknown. This study aimed to explore the 24hour changes in sodium and potassium in adult MICU patients at the UTH, Lusaka, Zambia. Methods: This was a prospective cohort study of the patients admitted to the MICU at UTH, Lusaka, Zambia. Data was collected over a four-month period (August to November) in 2017. Only consenting patients 18 years and above admitted for at least 24 hours in the unit were enrolled. On admission, routine baseline investigations were obtained from every patient which included a full blood count and renal function tests. The second set of investig...

PAMJ - One Health, 2021

INTRODUCTION: Sexual and gender-based violence (SGBV) is a global public health problem and women... more INTRODUCTION: Sexual and gender-based violence (SGBV) is a global public health problem and women are disproportionally affected. SGBV has an acute and chronic impact on health. We set out to apply autoregressive integrated moving average (ARIMA) models to make predictions on the number of SGBV cases reported to the Women and Newborn Hospital of the University Teaching Hospitals in Lusaka, Zambia. METHODS: we retrospectively collected monthly number of SGBV cases from April 2017 to December 2019 as a primary outcome measure. We utilized the following strategy for the analysis; we developed the Box-Jerkins methodology through identification, estimation and diagnostic checks before using the model for forecasting. Structural ARIMA models were used to model the number of SGBV cases. We considered the simplest parsimonious lowest order model based on the lowest volatility, highest log-likelihood value, most significant coefficients, and the lowest Akaike information criteria and Bayesian information criteria values. RESULTS: the ARIMA (1,1,1) model was able to forecast the number of SGBV cases. The forecasted mean monthly was 31.7 (95% CI: 29.9-33.3). The prediction error assessed by mean absolute percentage error was 10.3%, and the root mean standard error was 6.6. Further, a comparison of the observed and predicted values showed no statistically significant difference (p=0.753). CONCLUSION: the ARIMA model can be a useful tool for planners and clinicians to manage survivors of sexual and gender-based violence at the Women and newborn hospital.

The Lancet HIV, 2021

Summary Background Women with HIV face an increased risk of preterm birth. 17 alpha-hydroxyproges... more Summary Background Women with HIV face an increased risk of preterm birth. 17 alpha-hydroxyprogesterone caproate (17P) has been shown in some trials to reduce early delivery among women with a history of spontaneous preterm birth. We investigated whether 17P would reduce this risk among women with HIV. Methods We did a randomised, double-blind, placebo-controlled trial in pregnant women with HIV at the University Teaching Hospital and Kamwala District Health Centre in Lusaka, Zambia. Eligible patients were women aged 18 years or older with confirmed HIV-1 infection, viable intrauterine singleton pregnancy at less than 24 weeks of gestation, and were receiving or intending to commence antiretroviral therapy during pregnancy. Exclusion criteria were major uterine or fetal anomaly; planned or in situ cervical cerclage; evidence of threatened miscarriage, preterm labour, or ruptured membranes at screening; medical contraindication to 17P; previous participation in the trial; or history of spontaneous preterm birth. Eligible participants provided written informed consent and were randomly assigned (1:1) to receive 250 mg intramuscular 17P or placebo once per week, starting between 16 and 24 weeks of gestation until delivery, stillbirth, or reaching term (37 weeks). Participants and study staff were masked to assignment, except for pharmacy staff who did random assignment and prepared injections but did not interact with participants. The primary outcome was a composite of delivery before 37 weeks or stillbirth at any gestational age. Patients attended weekly visits for study drug injections and antenatal care. We estimated the absolute and relative difference in risk of the primary outcome and safety events between treatment groups by intention to treat. This trial is registered with ClinicalTrials.gov, NCT03297216, and is complete. Findings Between Feb 7, 2018 and Jan 13, 2020, we assessed 1042 women for inclusion into the study. 242 women were excluded after additional assessments, and 800 eligible patients were enrolled and randomly assigned to receive intramuscular 17P (n=399) or placebo (n=401). Baseline characteristics were similar between groups. Adherence to study drug injections was 98% in both groups, no patients were lost to follow-up, and the final post-partum visit was on Aug 6, 2020. 36 (9%) of 399 participants assigned to 17P had preterm birth or stillbirth, compared with 36 (9%) of 401 patients assigned to placebo (risk difference 0·1, 95% CI −3·9 to 4·0; relative risk 1·0, 95% CI 0·6 to 1·6; p=0·98). Intervention-related adverse events were reported by 140 (18%) of 800 participants and occurred in similar proportions in both randomisation groups. No serious adverse events were reported. Interpretation Although 17P seems to be safe and acceptable to participants, available data do not support the use of the drug to prevent preterm birth among women whose risk derives solely from HIV infection. The low risk of preterm birth in both randomisation groups warrants further investigation. Funding US National Institutes of Health and the Bill and Melinda Gates Foundation.

American Journal of Obstetrics and Gynecology, 2021