Lumbar Puncture-Related Knowledge, Attitudes, and Practices among Patients, Caregivers, Doctors, and Nurses in Zambia

Elafros, Melissa A.; Belessiotis, Clara; Birbeck, Gretchen L.; Bond, Virginia; Sikazwe, Izukanji; Kvalsund, Michelle

doi:10.4269/ajtmh.20-0509

Cited by 5 publications

(4 citation statements)

References 17 publications

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“…The poor uptake of LP in the region has previously been described in PLWHIV with new‐onset seizure in Zambia 26 . This issue is increasingly recognized and appears to be a multifactorial problem warranting further study 29‐31 . In the context of this study, the constrained diagnostic data negatively impacted the identification of seizure etiology and cause of death and may have contributed to the high 30‐day mortality.…”

Section: Discussionmentioning

confidence: 81%

“…26 This issue is increasingly recognized and appears to be a multifactorial problem warranting further study. [29][30][31] In the context of this study, the constrained diagnostic data negatively impacted the identification of seizure etiology and cause of death and may have contributed to the high 30-day mortality. Nonetheless, diagnostic data in this cohort are likely more extensive than are usually available.…”

Section: Discussionmentioning

confidence: 99%

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Clinical characteristics and outcomes after new‐onset seizure among Zambian children with HIV during the antiretroviral therapy era

et al. 2022

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Objective This study describes clinical profiles including human immunodeficiency virus (HIV) disease history and seizure etiology among children living with HIV presenting with new‐onset seizure during the era of antiretroviral therapy (ART) in Zambia. 30‐day mortality and cause of death are also reported. Methods Children living with HIV (CLWHIV) with new‐onset seizures were prospectively evaluated at one large urban teaching hospital and two non‐urban healthcare facilities. Interviews with family members, review of medical records, and where needed, verbal autopsies were undertaken. Two clinicians who were not responsible for the patients' care independently reviewed all records and assigned seizure etiology and cause of death with adjudication as needed. Results From April 2016 to June 2019, 73 children (49 urban, 24 rural) were identified. Median age was 6 years (IQR 2.2‐10.0) and 39 (53%) were male children. Seizures were focal in 36 (49%) and were often severe, with 37% presenting with multiple recurrent seizures in the 24 hours before admission or in status epilepticus. Although 36 (49%) were on ART at enrollment, only 7 of 36 (19%) were virally suppressed. Seizure etiologies were infectious in over half (54%), with HIV encephalitis, bacterial meningitis, and tuberculous meningitis being the most common. Metabolic causes (19%) included renal failure and hypoglycemia. Structural lesions identified on imaging accounted for 10% of etiologies and included stroke and non‐accidental trauma. No etiology could be identified in 12 (16%) children, most of whom died before the completion of clinical investigations. Twenty‐two (30%) children died within 30 days of the index seizure. Significance Despite widespread ART roll out in Zambia, new‐onset seizure in CLWHIV occurs in the setting of advanced, active HIV disease. Seizure severity/burden is high as is early mortality. Enhanced programs to assure early ART initiation, improve adherence, and address ART failure are needed to reduce the burden of neurological injury and premature death in CLWHIV.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcomes after new‐onset seizure among Zambian children with HIV during the antiretroviral therapy era

et al. 2022

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“…Perceptions of a heightened risk of death and paralysis were common among patients/caregivers and HCWs were wary of reinforcing this association by performing LP when patients were extremely ill. Concerns about LP-related risks have been commonly reported in our patient population 18 as well as elsewhere in Africa, Asia, and the Middle East, and have been associated with increased LP refusal by patients and their caregivers. [8][9][10]19 In this study, these attitudes were a result of prior experiences with LP among seriously ill individuals as well as limited understanding of the procedure.…”

Section: Discussionmentioning

confidence: 85%

A qualitative study of patient, caregiver, doctor and nurse views of factors influencing lumbar puncture uptake in Zambia

Elafros

Belessiotis-Richards

Birbeck

et al. 2021

Transactions of the Royal Society of Tropical Medicine and Hygiene

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Background Uptake of lumbar puncture (LP) remains low in regions with a high prevalence of central nervous system (CNS) infections like Zambia. Efforts to improve uptake are hindered by limited understanding of factors influencing LP uptake. Methods Semistructured qualitative interviews were conducted with patients with suspected CNS infection, caregivers, doctors and nurses at the University Teaching Hospitals in 2016. Questions focused on LP experiences, knowledge, the consent process and health system barriers to LP among patients with an LP indication. Interviews were transcribed, translated to English and analysed using a thematic approach. Results We recruited 24 adult patients, 36 caregivers of adult patients, 63 caregivers of paediatric patients, 20 doctors and 30 nurses (173 in total). LP barriers arose from both patients/caregivers and health providers and included community apprehension about LP, proxy (family) consensus consent practices, competing clinical demands, wariness of patient/caregiver responses, limitations in consumables and time to complete the LP. This could result in consent not being obtained correctly. LP enablers included patient/caregiver perceived LP utility, provider comfort with LP and in-person counselling. Conclusions LP uptake is a complex sociocultural process influenced by patient, healthcare and community-level factors. Interventions to improve uptake must address multiple barriers to be successful.

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“…E cient identi cation of meningitis cases remains a challenge in LMICs, where scarce resources often result in underdiagnosis. This underscores the urgent need to improve screening strategies to identify potential cases of ABM, as delayed diagnosis and treatment signi cantly increase morbidity, sequelae, and mortality rates [24][25][26][27][28] . In this scenario, a non-invasive screening tool for ABM could help identifying the cases that need to be referred to a health facility with the capacity to perform LPs, to prioritize the scarce available results, and, if necessary, start empirical treatment when no other options are available.…”

Section: Discussionmentioning

confidence: 99%

Meningitis Screening in Young Infants Based on a Novel, Non- Invasive, Transfontanellar Ultrasound Device: a Proof-of- Concept Study

Ajanovic,

Jobst,

Jiménez

et al. 2023

Preprint

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Background Meningitis is a potentially life-threatening disease if not promptly diagnosed and treated. Clinical presentation is often unspecific, especially among young infants and newborns, justifying the need to perform lumbar punctures (LP) to obtain cerebrospinal fluid (CSF) for a laboratory-based confirmation. In high-income settings, LPs are often part of the protocolized systematic approach to screen for meningitis. Given its relatively low incidence, most are not confirmatory. The aim of this study was to validate a novel transfontanellar ultrasound-based technique to screen for meningitis, designed to non-invasively identify ranges of white blood cells (WBC) in CSF, to be used on patients with criteria for a LP. Methods We prospectively recruited patients under one year of age, with suspected meningitis, a permeable fontanelle and a LP performed within 24h before enrolment, from three Spanish University Hospitals (2021–2023). Images showing the backscatter pattern from CSF were obtained using a customized high-resolution (HR) ultrasonic probe. A deep-learning model (DL) was trained to classify CSF patterns according to WBC values obtained through the LP, setting a 30 cells/mm3 threshold to differentiate controls from cases. Results We obtained a set of 781 HR CSF images from 16 targeted and recruited patients. In parallel, 17 LPs were performed, confirming 6 meningitis cases (one patient had a second LP to verify response to treatment) which were paired to 445 CSF frames, and 10 controls, with 336 CSF images. After training the DL model, the device showed a sensitivity of 100% and a specificity of 90% at patients' level, with one control misclassified. Conclusion This proof-of-concept study confirmed that our device, based on ultrasound and DL, could potentially be used as an automated screening method to modulate indications to perform LPs.

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Lumbar Puncture-Related Knowledge, Attitudes, and Practices among Patients, Caregivers, Doctors, and Nurses in Zambia

Cited by 5 publications

References 17 publications

Clinical characteristics and outcomes after new‐onset seizure among Zambian children with HIV during the antiretroviral therapy era

Clinical characteristics and outcomes after new‐onset seizure among Zambian children with HIV during the antiretroviral therapy era

A qualitative study of patient, caregiver, doctor and nurse views of factors influencing lumbar puncture uptake in Zambia

Meningitis Screening in Young Infants Based on a Novel, Non- Invasive, Transfontanellar Ultrasound Device: a Proof-of- Concept Study

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