School of Medicine

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Knowledge and attitudes of infection prevention and control among health sciences students at University of Namibia
(2012) Ojulong, J.; Mitonga, Kabwebwe H.; Iipinge, S.N.
Background: Health Sciences students are exposed early to hospitals and to activities which increase their risk of acquiring infections. Infection control practices are geared towards reduction of occurrence and transmission of infectious diseases. Objective: To evaluate knowledge and attitudes of infection prevention and control among Health Science students at University of Namibia. Methods: To assess students’ knowledge and attitudes regarding infection prevention and control and their sources of information, a self-administered questionnaire was used to look at standard precautions especially hands hygiene. Results: One hundred sixty two students participated in this study of which 31 were medical, 17 were radiography and 114 were nursing students. Medical students had better overall scores (73%) compared to nursing students (66%) and radiology students (61%). There was no significant difference in scores between sexes or location of the high school being either in rural or urban setting. Conclusion: Serious efforts are needed to improve or review curriculum so that health sciences students’ knowledge on infection prevention and control is imparted early before they are introduced to the wards.
Implications of the 2015 World Health Organization isoniazid preventive therapy recommendations on Tuberculosis prevention efforts in Namibia
(2016) Oloo, Stella A.
The World Health Organization recently released guidelines recommending 36-month use of isoniazid preventive therapy in adults and adolescents living with HIV in resource-limited settings. Namibia continues to grapple with one of the highest incidences of tuberculosis (TB) worldwide. Implementation of these guidelines requires considerations of TB epidemiology, health infrastructure, programmatic priorities and patient adherence. This article explores the challenges Namibia currently faces in its fight against TB and the implications of the new guidelines on Namibian TB prevention efforts.
Molecular detection of P. vivax and P. ovale foci of infection in asymptomatic and symptomatic children in Northern Namibia
(2019) Haiyambo, Daniel H.; Uusiku, Petrina; Mumbengegwi, Davis R.; Pernica, Jeff M.; Bock, Ronnie; Malleret, Benoit; Renia, Laurent; Greco, Beatrice; Quaye, Isaac K.
Knowledge of the foci of plasmodium species infections is critical for a country with an elimination agenda. Namibia is targeting malaria elimination by 2020. To support decision making regarding targeted intervention, we examined for the first time, the foci of Plasmodium species infections and regional prevalence in northern Namibia, using nested and quantitative polymerase chain PRC methods.
Assessment of neural tube deffects in two Northern Namibia hospitals: Incidence, seasonal variation, risk factors and prevention strategies for folate sensitive defects
(University of Namibia, 2021) Amaambo, Filemon
Neural tube defects (NTDs) represent severe congenital abnormalities of the nervous system and are among significant abnormalities associated with a high mortality and morbidity rates. Studies reported that the incidence of NTDs varies worldwide, with the highest found in low-income countries. Most high-income countries have managed to document and the reduce incidence of NTDs through primary prevention strategies. However, inadequate documentation on NTDs is frequent in low and upper-middle income countries including Namibia. This study focused on assessing the incidence, seasonal variation, risk factors, and comparing the postpartum red blood cell folate in cases and controls in Onandjokwe and Oshakati hospitals in the Northern regions of Namibia over 12 months. The aims of the study were to identify evidence that NTDs constitute both a clinical and a societal problem. And, to propose locally adapted prevention strategies for folate –sensitive NTDs. The study objectives were to assess the incidence of NTDs, determine an association between the conception of NTD babies and seasonal variation (rainfall), identify related risk factors, and to compare postpartum maternal red blood cell folate in NTD cases and controls. The study utilised a quantitative approach with a cross-sectional design to assess the incidence of NTDs and descriptive-statistical analysis to evaluate associated risk factors. A case-control design was used to compare postpartum maternal red blood cell folate between mothers of cases and controls. The study population was mothers who gave birth in the two hospitals during the period of 12 months. Non-random consecutive sampling was used to select participants - mothers with and without NTD babies - to minimise bias when studying rare conditions. Participants were informed, counselled and requested to sign consent forms. Questionnaires were administered face to face to participants and blood samples were drawn to determine postpartum red blood cell folate. Data was analysed using Epi-info software. The findings of the study were: a) the combined hospital neural tube defects incidence was 11 per 10000 births; b) there was a seasonal variation in the birth and conception of babies with NTDs, which could be associated with the seasonal rainfall pattern; c) the risk factors possibly related to NTDs were unemployment, low level of education, diet lacking fruits and vegetables, and low maternal red blood cell folate. Other risk factors, such as age, diabetes, HIV, obesity, smoking, alcohol, drugs, exposure to radiation, hyperthermia, family history, marriage, consanguinity, were not shown to play a significant role in NTD incidence. The study found hydranencephaly to be more common than spina bifida. The study proposed recommendations, future research areas and preventive interventional strategies for NTDs in the Northern regions. The study further underscored health education about NTDs, consumption of fruits and vegetables, folate supplementations + Vit B12 and food fortification for all childbearing women in a sustainable way.
Prophylactic phenylephrine bolus versus infusion for prevention of maternal hypotension during spinal anaesthesia for caesarean section at Windhoek-based teaching hospitals, Namibia
(University of Namibia, 2022) Shaanika, Ebba Panduleni
Background: Maternal hypotension is a common complication of spinal anaesthesia during caesarean delivery. Injection of vasopressors with non-pharmacological measures have been investigated for prevention of martenal hypotension as well as the foeto-maternal effects of treatment. Aim: The primary aim of the study was to compare prophylactic 50 mcg phenylephrine bolus (PB) with a fixed continuous 25 mcg/min phenylephrine infusion (PI). The secondary aim was to assess the side effects and neonatal outcomes of the two treatments. Settings and design: A prospective, randomised, controlled double-blinded study was conducted in the maternity theatres of Windhoek Central Hospital and Katutura Intermediate Hospital. Methods and Materials: Ninety-two eligible parturients, ASA I and II, scheduled for elective caesarean section under spinal anaesthesia were recruited and randomised into two groups. PB group received a prophylactic 50 mcg phenylephrine (PE) bolus immediately after spinal anaesthesia whereas PI group received prophylactic 25 mcg/min PE infusion. Maternal blood pressure, heart rate and side effects were recorded every minute for the first 20 minutes while neonatal outcome was assessed with Apgar score at the 1st and 5th minute. Statistical Analysis: Categorical variables were presented in numbers and percentages. Normally distributed continuous variables were presented as mean standard deviation (±SD) and compared using t-test. Non normally distributed continuous variables were compared with Mann-Whitney test. A p-value of p< 0.05 was considered significant. Results: Parturients in the PI group had a significantly lower incidence of hypotension than PB group (32% vs 71% p = 0.0001). Nausea and vomiting was lower in PI group than PB group (13% vs 31% p = 0.033). Reflex bradycardia was comparable between groups (p= 0.489). No parturient in the PB group had reactive hypertension whereas 11% of participants in PI group did (p=0.024). Participants in the PI group received about 36% more phenylephrine than the PB group (p=0. 0277). Apgar scores between the two groups showed good neonatal outcomes. Conclusion: There was better control of blood pressure in the PI group than PB group. Both groups had similar incidence of reflex bradycardia as well as good neonatal outcomes. Intraoperative nausea and vomiting (IONV) was higher in the PB group than PI group, whereas no reactive hypertension experienced in PB group.
A comparison of intrathecal morphine or fentanyl on the duration of postoperative analgesia at Namibian teaching hospitals in Windhoek
(University of Namibia, 2022) Murakwani, Mandiudza Maria
Background: Pain management is a cornerstone in the management of femoral fractures. Poorly controlled perioperative pain is associated with detrimental short-term and long-term effects. Addition of intrathecal opioids has been shown to produce a dense block and enhance analgesic effect. The objective of the study was to compare the duration of postoperative analgesia of intrathecal morphine or fentanyl for femur fracture surgery at Namibian Teaching Hospitals in Windhoek. Methodology: This was a prospective randomised double blinded control study which was done in February – July 2021; in which 60 patients above 18 years scheduled for femur fracture surgeries received standard spinal anaesthesia with 0.5% heavy bupivacaine 12.5 mg plus 100 mcg morphine (ITM group) or 25 mcg fentanyl (ITF group). Data was collected using a form designed for the study and analysed with the statistical package for social sciences (SPSS for windows 26.0, SPSS Inc., Chicago, IL, USA). Results: Participants in the ITM group had a significantly longer time to first request for analgesic (14.5 ±8.03 hours) versus the ITF group (7.07 ± 3.07 hours), p =0.0001 and reduced total opioid consumption in 24 hours. The postoperative pain scores (verbal numerical rating scale) at rest and with movement were significantly lower in 2nd, 4th and 6th hour in the ITM group compared to the ITF group (p <0.05). No significant difference was observed between the two groups in terms of pruritus, nausea and vomiting. Respiratory depression was not observed in any participant in the two groups. Patient satisfaction with analgesia was superior in the ITM group (p =0.0001). No significant association was confirmed between type of femur fracture and the total opioid consumption in 24 hours. Conclusion: Use of intrathecal morphine significantly increased the duration of postoperative analgesia and reduced the total opioid consumption.
A survey on end of life care practices in intensive care units of three government teaching hospitals in Namibia
(University of Namibia, 2022) Shivolo, Loini Talishi
Background: End of life (EOL) care may be described as care provided for patients in the final hours or days of their life. More broadly it’s defined as care for all patients with a terminal illness that is deemed progressive and incurable. It implies a focus on pain and symptom management which is distinct from the aggressive pursuit of investigation and therapies focused on cure. End of life care in the ICU however involves a substantial degree of emotional and psychological stress both for health care providers as well as the family members. Significance of the study: The study aimed to evaluate the current practices of EOL care in a lifesaving department like the intensive care unit. It also intended to evaluate the knowledge of EOL care practices among ICU health professions and to identify gaps that would require improvement. Methodology: This was a mixed study that used the sequential explanatory design. It had a quantitative study phase 1 and a qualitative study phase 2. The quantitative method looked at the experience of health care workers on EOL care as the dependent variable with relation to age, training background, gender, and years of employment and facility of employment. The qualitative method approach was used to assess the knowledge and attitudes of family members and health care providers on EOL care. This methodology was achieved through cross-sectional surveys and a series of questionnaire-based interviews. Findings: About 59.7% of the respondents had never heard the term EOL care. In addition, less than half of them reported that the decision to offer EOL care to patients rested with the attending physicians. Furthermore, 50% of the study participants believed that family members do not take part in the decision to offer their patients EOL care. Conclusion: EOL is an essential part of patient management. Not only for the patient but also focuses on family members and health care workers as it has an effect on their emotional, mental health, as well as physical health. Recommendations: Improve communication between health care workers and family members and continuous medical education to be offered to health care workers on EOL care.
Evaluation of the effect of 2.5 IU vs 5 IU oxytocin on uterine tone during elective caesarean section at Windhoek hospital complex: A double-blind randomized controlled clinical study
(University of Namibia, 2022) Nembale, Fredrika Nembale
Introduction: Oxytocin is routinely administered during caesarean delivery to initiate and maintain uterine tone (UT) after delivery of the baby. It reduces blood loss thus preventing postpartum haemorrhage (PPH). However higher doses of oxytocin are associated with unwanted side effects namely; cardiovascular effects, headache as well as nausea and vomiting. However, the optimal dose of oxytocin at caesarean delivery remains ambiguous among various official bodies. This study compared the effect of two doses of oxytocin 2.5 IU vs 5 IU on uterine tone, haemodynamic changes, blood loss and side effects. Methodology: A double-blinded, randomized controlled clinical study was conducted at Windhoek Teaching Hospitals Complex. Eighty (80) parturients undergoing elective caesarean section under spinal anaesthesia received an intravenous bolus of either 2.5 IU (n=40) or 5 IU (n=40) of oxytocin after delivery followed by an infusion of 5 IU/hr. Uterine tone, haemodynamic changes, side effects and blood loss were compared between the two groups. The two groups were statistically compared using a two-sided, independent samples t-test with a P-value set at 0.05 (5%) critical level of significance using the per-protocol analysis. Results: The two groups were comparable in terms of demographic characteristics. Parturients in both study groups had adequate uterine tone at 3 minutes with a median (SD) score of 3.28(0.51) for the 2.5 IU group and 3.20(0.56) for the 5 IU group. A rapid increase in heart rate (HR) was seen in the 5 IU group with a mean increase of 17(17) and 12(16) beats/min at 1 min and 2 min with a p-value of 0.000 and 0.005 respectively. Higher incidence of nausea, headache and chest pain (40%, 25%, 15%) were noted in the ii 5 IU group compared to (15%, 2.5%, 0%) in the 2.5 group. Blood loss did not differ among the two groups. Conclusion: 2.5 IU of oxytocin bolus was compared and non-inferior to 5 IU oxytocin bolus in initiating and maintaining adequate uterine tone and it was associated with fewer haemodynamic changes and other adverse effects.
Designing and characterizing the plant-based chitosan-modified poly (lactic-co-glycolic acid) nanoparticles for salmonella and e. coli-induced gastroenteritis
(University of Namibia, 2023) Shatri, Albertina M. N.
A global mortality rate of over 1.6 million deaths was reported in 2017 due to gastroenteritis. The highest mortality rate is reported annually in sub-Saharan Africa and South Asia. In Namibia, the national prevalence of gastroenteritis was 17% in 2014 and to date, gastroenteritis is responsible for 5% of all deaths in children under the age of 5. In the Ohangwena region, 23.8% of children were reported to have gastroenteritis from a total sample size of 530 children in 2020. Salmonella species and Escherichia coli were responsible for most bacterial gastroenteritis cases reported in Windhoek in 2018. Some of the key challenges in the management of gastroenteritis are: 1) Antibiotics and antidiarrheal agents used in the treatment of gastroenteritis have side effects in children and immunocompromised patients. 2) The high treatment doses required for the effective treatment of gastroenteritis are harmful to the beneficial microbiota within the digestive system. 3) Salmonella species and E. coli which cause gastroenteritis, have shown over 60% resistance to the available antibiotics. 4) Many orally administered antibiotics and antidiarrheal agents have reduced bioavailability at the site of infection, within the alimentary canal. Extracts derived from medicinal plants are used in ethnomedicine in African countries including Namibia as alternative treatments for Salmonella and E. coli induced gastroenteritis. However, the lack of information on the presence and quantity of bioactive compounds present, their safety, and efficacy. Moreover, plant-based treatments are faced with numerous challenges within the GI tract which reduce their bioavailability and efficacy limiting their mainstream uses in treating gastroenteritis. The use of stable nano-particles that deliver plant-based medicine has attracted attention in the field of drug development. Such an approach could be an option for effectively delivering plant-based ii medicines, safely to the lower gastro intestinal tract, the site of Salmonella and E. coli with the added benefits of controlled release at this site to increase bioavailability reducing required doses. Benefits would also include reduced side effects and higher efficacy of antidiarrheal compounds from medicinal plant extracts. This study then aimed at designing and characterizing the plant-based chitosan-modified poly (lactic-co-glycolic acid) nanoparticles for Salmonella and E. coli-induced gastroenteritis. Medicinal plants used as an alternative treatment for gastrointestinal infection were collected from Iikokola village in the Omusati region in Namibia. Organic and aqueous extracts were prepared from the collected plants, screened for the present bioactive compounds, and tested for their potential in eliminating multidrug-resistant clinical and reference strains of Salmonella and E. coli that are commonly associated with bacterial gastroenteritis. The antibacterial activity against clinical and reference strains of Salmonella and E. coli and cytotoxicity to human fibroblast cells (NIH/3T3) of prepared extracts were also determined. Plant extracts with potent antibacterial activity against clinical and reference strains of Salmonella and E. coli were encapsulated into poly (lactic-co-glycolic acid) nanocarriers coated with chitosan (CMPLGA) and characterized nanoparticles’ morphology, size, zeta potential, polydispersity index, encapsulation efficacy, and pH based in vitro release in simulated gastrointestinal tract conditions. Furthermore, the stability of the designed nanoparticles was determined by monitoring the physicochemical properties, in-vitro cytotoxicity, and antibacterial activity of lysed and un-lysed nanoparticles stored at 4 and 25 ºC for 24 weeks. As part of this study, an ethnomedicinal survey was conducted and 19 medicinal plants that are used in Iikokola village to treat gastrointestinal conditions and other diseases were iii documented. Crude extracts of five of the frequently used medicinal plants used in this study (Lantana camara, Terminalia sericea, Grewia tenax, Albizia anthelmintica, and Chorcorus trides) were used to validate the phytochemical compositions of these plants and were found to contain multiple bioactive compounds. The collected plants showed potent antibacterial activity against multidrug-resistant clinical Salmonella and E. coli strains. Mild cytotoxicity to the mouse fibroblast cells (NIH/3T3) line was observed for the five plant extracts. All extracts showed an IC50 above 50 µg/ml. Encapsulating the selected plant extracts in CMPLGA enhanced the antibacterial properties of the plant extracts, reduced the cytotoxicity, and improved the in vitro release properties of the encapsulated extracts at pH 1.2 and 7.4. Lastly, factors such as lyophilization showed a change in the physicochemical properties of the formulated CMPLGA nanoparticles. Prolonged storage at 25 ºC tremendously reduces the efficacy of the CMPLGA nanoparticle, while storing at 4 ºC has only shown a minimal decrease in the efficacy of the CMPLGA nanoparticles. Overall, the use of CMPLGA nanoparticles enhanced the antibacterial activity of the plant extracts in this study and improved their in vitro release properties in simulations at a pH of 1.2 (stomach pH) and 7.4 (ileum pH). The use of CMPLGA nanoparticles also reduced the cytotoxicity of the extracts by over 20%. The toxicology and release properties of the formulated CMPLGA nanoparticles should be evaluated in an in vivo model as part of their development for mainstream use in treating Salmonella and E. coli-induced gastroenteritis.

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