Browsing by Author "Mapiki Chileleko"

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    Factors Associated with Adherence to Anti-Hypertensive Medication Among Patients Attending a Primary Health Centre in Ndola, Zambia: A Cross-Sectional Study
    Sikantongwe Nancy; Musonda Elliot; Mabaso Florence; Sikantongwe Erick; Chibwaya Elipilious; Mapiki Chileleko
    ABSTRACT Background Hypertension is a leading modifiable risk factor for cardiovascular disease and premature death worldwide. Despite effective pharmacological therapy, poor adherence to anti-hypertensive medication remains the primary barrier to achieving blood pressure control, with non-adherence rates reaching 45-65% in sub-Saharan African settings. In Zambia, uncontrolled hypertension contributes substantially to hospital morbidity and mortality, yet context-specific data on adherence barriers remain limited. This study assessed factors associated with adherence to anti-hypertensive medication among patients attending Railway Surgery Urban Health Centre in Ndola, Zambia. Methods A cross-sectional study was conducted among 237 hypertensive patients attending Railway Surgery Urban Health Centre in Ndola. A structured, interviewer-administered questionnaire assessed socio-demographic characteristics, clinical factors, and medication adherence using the modified Hill-Bone Compliance Scale. Data were analysed using descriptive statistics, chi-square tests, and multivariable logistic regression (p<0.05). Results The overall adherence rate was 41.4%, with 58.6% of participants classified as non-adherent. The mean adherence score was 19.8 (SD=4.6) out of a possible 32. The most common reasons for non-adherence were running out of pills (mean=2.6), being away from home (mean=2.5), and forgetting to take medication (mean=2.4). Age (p=0.006), education level (p=0.001), and monthly income (p=0.001) were significantly associated with adherence. Clinical factors significantly associated with poorer adherence included presence of comorbidities (p=0.027), experience of side effects (p<0.001), and medication regimen complexity (p=0.007). Multivariable analysis identified age ≥51 years (AOR=2.89-3.24), secondary/tertiary education (AOR=2.84-3.56), monthly income ≥K1,000 (AOR=2.21-5.89), absence of comorbidities (AOR=0.51), absence of side effects (AOR=0.36), and simpler regimens (AOR=0.34) as factors independently associated with adherence. Health system barriers included long distances, reliance on public transport, missed appointments due to transport problems (35.4%), medication stock-outs (38.4%), and inadequate counselling time (49.8% received <5 minutes). Conclusion Adherence to anti-hypertensive medication at Railway Surgery Urban Health Centre is suboptimal, with multiple socio-demographic, clinical, and health system factors associated with non-adherence. Interventions should focus on regimen simplification, proactive side effect management, enhanced patient education, and addressing systemic barriers including medication supply and transport access.
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    Investigating the Determinants of Cervical Cancer Disease State Among Women Living with HIV at Cancer Disease Hospital in Zambia: A Retrospective Cross-Sectional Study
    Santos Tembo; Mapiki Chileleko; Kombe Maureen Mupeta; Charles Michelo
    ABSTRACT Background Cervical cancer is the most common malignancy among Zambian women, and HIV co-infection accelerates disease progression. However, in the contemporary era of widespread antiretroviral therapy, the determinants of cervical cancer disease state among women living with HIV at Zambia’s primary oncology referral centre are not fully understood. This study aimed to investigate these determinants at the Cancer Disease Hospital in Lusaka. Methods An analytical cross-sectional study was conducted using medical records of 198 WLHIV with histologically confirmed invasive cervical cancer. Data on demographics, HIV status (CD4 count, viral load), and cancer characteristics (FIGO stage) were abstracted. Descriptive statistics, bivariate analyses, and multivariable logistic regression were performed. Results The prevalence of advanced-stage (Stage III/IV) cervical cancer was 34.4% (68/198), while 54.5% presented with Stage IIB disease. Metastatic disease was only 7.1% (14/198). The peak age of diagnosis was 40–49 years (51.5%). Median CD4 count was 484 cells/uL, and 89.4% had suppressed viral loads. No significant association was found between HIV disease status and advanced-stage cancer (CD4 <200: AOR 1.42, 95% CI 0.68–2.96; detectable viral load: AOR 1.38, 95% CI 0.71–2.68). Younger WLHIV aged 30–39 years had the highest proportion of advanced-stage disease (38.5%), as did peri-urban residents (40.0%) compared to Lusaka residents (30.0%). Conclusion In the ART era, HIV disease status is no longer the dominant determinant of cervical cancer stage among WLHIV at CDH who develop invasive cancer, likely due to effective immune reconstitution. However, persistent Stage IIB presentation indicates inadequate screening coverage. Younger WLHIV and peri-urban residents are at highest risk of late-stage diagnosis.