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Kasonde Bowa

University Of Lusaka, Clinical Sciences, Deputy Vice Chancellor and Dean School of medicine and Public health

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I am Professor of Urology and Consultant Urologist at the University Teaching Hospitals in Lusaka and Ndola in Zambia, as well as the Arthur Davison childrens Hospital in Ndola Zambia. I have been Lecturing at in Medical Schools for the last 31 years. These include the University of Zambia School of Medicine for 21 years, the Michael Chilufya Sata Copperbelt University School of Medicine for 9 years, and the University of Lusaka School of medicine and Health Sciences for 3 years. During this period I have held the academic positions of Associate Professor at the University of Zambia, Full Professor at the Copperbelt University and Full Professor at the University of Lusaka.In addition I have held academic positions as Assistant Dean (Postgraduate) at the UNZA SOM for 6 years, Founding Dean at the CBU SOM for 7 years and Dean and Deputy Vice Chancellor (Research) at the UNILUS. I have an RG Score of 29, Hirsch index 10 of 15, I have close to 1,000 citations. i have over 70 peer review publications and over 50 podium presentations. I am a specialist in Urology, General Surgery, Anatomy and Medical Education
Supervisors: Prof Pinalo Chifwanakenyi

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Papers by Kasonde Bowa

Urinary Retention due to Imperforate Hymen - A Case Series

Four cases are reported, of young girls in their early teens with urinary retention due to imperf... more Four cases are reported, of young girls in their early teens with urinary retention due to imperforate hymen. The girls presented to the University Teaching Hospital Lusaka Zambia with history of recurrent episodes of urinaryretentionduringtheirmenses.Uponexaminations they were found to have hematocolpos and thickened hymen, which ranged from complete to partially imperforate. Ultrasound studies showed evidence ofnonhomogenous echogenic masses suggestive of blood in the uterus. These patients were referred to the obstetrics department where the diagnosis was confirmed and subsequent excision of hymen with uterine evacuations was done. No subsequent episodes of urinary retention were observed. Urinary retention is the commonest cause of emergency admissioninurologyattheuniversityTeachingHospital Lusaka. It is more common in men than women. It is even uncommon in young teenage women. These case reports highlight the importance of high index of suspicion, careful examination and reprod...

Zambian Parents’ Perspectives on Early-Infant Versus Early-Adolescent Male Circumcision

AIDS and Behavior

The use of bladder voiding efficiency in assessing benign prostatic enlargement

African Journal of Urology

Background The management of benign prostatic enlargement (BPE) in low resource settings poses a ... more Background The management of benign prostatic enlargement (BPE) in low resource settings poses a major challenge in Africa. The objective of the study was to investigate the accuracy of Bladder Voiding Efficiency (BVE) to assess lower Urinary Tract Symptoms (LUTS) among BPE patients in a low resource setting. Methods From December 2017 to March 2018, patients with benign prostatic enlargement (BPE) and Lower Urinary Tract Symptoms (LUTS) were recruited into the study. The study was a prospective cross-sectional study. Participants had the International Prostate Symptom Score (IPSS) recorded followed by evaluation of their Bladder Voiding Efficiency (BVE). The BVE was calculated as the ratio of the volume of Urine voided over total volume of Urine in the bladder at the time of the void. The data were analysed to show the Sensitivity and Specificity of BVE in symptomatic LUTS. The Pearson correlation co-efficient between IPSS and BVE was analysed. Results The study recruited 94 partic...

The Accuracy of Bladder Voiding Efficiency to Predict the Severity of Lower Urinary Tract Symptoms in Benign Prostatic Enlargement Patients at Ndola Teaching Hospital, Ndola , Zambia

Background The management of Benign Prostatic Enlargement (BPE) in low resource settings poses a ... more Background The management of Benign Prostatic Enlargement (BPE) in low resource settings poses a major challenge in Africa. The objective of the study was to investigate the accuracy of Bladder Voiding Efficiency (BVE) to assess lower Urinary Tract Symptoms (LUTS) among BPE patients in a low resource setting. Methods From December 2017 to March 2018, patients with Benign Prostatic Enlargement (BPE) and Lower Urinary Tract Symptoms (LUTS) were recruited into the study. The study was a prospective cross-sectional study. Participants had the International Prostate Symptom Score (IPSS) recorded followed by evaluation of their Bladder Voiding Efficiency (BVE). The BVE was calculated as the ratio of the volume of Urine voided over total volume of Urine in the bladder at the time of the void. The data was analysed to show the Sensitivity and Specificity of BVE in symptomatic LUTS. The Pearson correlation co-efficient between IPSS and BVE was analysed. Results The study recruited 94 partici...

s response to reviews Title : Household Secondhand Smoke Exposure of Elementary Schoolchildren in Southern Taiwan and Factors Associated with their Confidence in Avoiding Exposure : a Cross-sectional Study

Ambiguous genitalia in rural Africa and the complexities of management:Which way forward?

East and Central African Journal of Surgery, 2008

Intersex disorders are amongst the most controversial conditions managed by doctors today. Althou... more Intersex disorders are amongst the most controversial conditions managed by doctors today. Although the diversity of their presentations demands broad classifications to help standardize management guidelines, each patient remains unique, requiring individualized care. The authors review the prevailing schools of thought on gender determination, assignment and re-assignment of intersex patients. The “liberal” views on sexuality, as espoused in current Western literature, vis-a-vis the “traditional” views of the average rural African community on sexuality are noted. The case histories of four patients highlight the diversity of presentations as well as the challenges in their management in a rural Kenyan hospital.

A single case report of Vulval Stenosis and its management

Clinical Case Reports and Reviews, 2018

Peer Review #2 of "Transcultural adaptation and validation of the questionnaire “Urgency, Weak stream, Incomplete emptying and Nocturia (UWIN)” for the Brazilian Portuguese (v0.1)

Lower urinary tract symptoms (LUTS) are common complaints in the adult male population and have a... more Lower urinary tract symptoms (LUTS) are common complaints in the adult male population and have a negative affect in the quality of life and represent an economic burden for the healthcare system worldwide. The International Prostatism Symptom Score (IPSS) is a validated tool for assessing these symptoms, but patients with low literacy may have difficulties comprehending and completing it accurately. The Urgency, Weak Stream, Incomplete Emptying, and Nocturia (UWIN) questionnaire was developed as a shorter tool in the assessment of LUTS to improve accuracy and minimize error. This study aimed at performing cross-cultural adaptation to Brazilian Portuguese and validation of UWIN questionnaire for patients with LUTS. The cross-cultural adaptation followed the steps of conceptual, item, semantic, operational, and pre-test equivalence to obtain the UWIN-Br version. The IPSS (gold standard) and UWIN-Br were coadministered, and information regarding the uroflowmetry examination was also recorded. We evaluated 306 men, median age 59 [52-66] years .There was a positive correlation r = 0.804 (p <0.001) between the total IPSS score and the total UWIN-Br score, as well as the quality of life question (r = 0.761) (p <0.001). The Bland-Altman plot showed good agreement between. Also, we observed that the maximum flow values decreased with the severity of the LUTS. UWIN-Br demonstrated excellent diagnostic accuracy in detecting the most severe cases. The area under the ROC curve was 89% [81-97%] 95% CI. 280 (91.5%) subjects completed the questionnaires without help, while 26 (8.5%) did so through an interview. The response time was 1.2 [1.0-1.5] min for UWIN-Br and 2.8 [2.2-3.4] min for IPSS (p <0.001). UWIN-Br presents satisfactory and similar psychometric properties to the IPSS in the evaluation of LUTS and quality of life and is suitable for use in both clinical practice and research in our country.

Acknowledgment of Reviewers, 2018

Journal of Global Oncology, 2018

It is with great appreciation that we acknowledge the following reviewers who have served our res... more

Variations in Origin and Course of the Right and Left Coronary Arteries in Autopsied Hearts at the University Teaching Hospital, Lusaka, Zambia

International Journal of Anatomy & Applied Physiology, 2016

Background: Coronary arteries play an important role in perfusion of the heart tissues. Variation... more Background: Coronary arteries play an important role in perfusion of the heart tissues. Variations or anomalies in coronary arteries may be asymptomatic while some can be symptomatic and even cause sudden death. Knowledge of coronary artery variations is important in diagnosis and treatment of cardiovascular diseases. Aim: To describe coronary artery anomalies and their incidence in autopsy cases. Materials and Methods: We dissected and grossly examined a total of 127 human hearts during autopsy to describe coronary artery variations in origin and course. Results: The incidence of coronary artery anomalies was found to be 4.72% (6/127; 1 female and 5 males). Among the coronary artery anomalies were: Absent left main coronary artery (LMCA) in 0.8% (1/127), origin of both the left and right coronary arteries from a common ostium located in the left aortic sinus in 0.8% (1/127), origin of both the left and right coronary arteries from a common trunk whose ostium was located in the right aortic sinus in 0.8% (1/127), origin of both the left and right coronary arteries from a common ostium located in the tubular part of the ascending aorta just above the right aortic sinus (RAS) in 0.8% (1/127), origin of the left coronary artery from a separate ostium in the RAS in 0.8% (1/127), origin of the right coronary artery from the sinutubular junction of the LAS in 0.8% (1/127) of the hearts. Conclusion: The incidence of coronary artery anomalies in autopsied hearts was found to be 4.72%. Knowledge of the normal and variant anatomy of coronary arteries is indispensable and imperative both in diagnosis, treatment and implementation of interventional measures.

Track C Epidemiology and Prevention Science

Journal of the International AIDS Society, 2012

Background: Dual infection with HIV-1 and HIV-2, which is not uncommon in West Africa, has import... more Background: Dual infection with HIV-1 and HIV-2, which is not uncommon in West Africa, has important implications for transmission, progression, and antiretroviral therapy. Few studies have examined HIV viral dynamics in this setting. Methods: We compared HIV-1 and HIV-2 viral loads from 65 dually infected, antiretroviral therapy-naïve Senegalese subjects. Participants provided demographic information and blood, oral fluid, and cervicovaginal lavage (CVL) or semen samples for virologic and immunologic testing. Associations between HIV-1 and HIV-2 levels in plasma, PBMC, oral and genital samples were assessed using linear regression models with generalized estimating equations to account for subjects with multiple samples over time. Results: In analyses adjusting for CD4 count, age, sex, and commercial sex work, HIV-1 RNA levels were significantly higher than HIV-2 levels in semen (b02.05 log 10 copies/ml, 95% CI 0.44 to 3.66), CVL (b 01.37, 95% CI 0.83 to 1.91), and oral fluids (b 01.93, 95% CI 1.56 to 2.30). HIV-1 and HIV-2 PBMC viral DNA loads were similar in those with normal immune function (CD4 counts above 500 cells/ml) (b 00.17 log 10 copies/mg of PBMC DNA, 95% CIÁ0.58 to 0.24), but compared to those with high CD4 counts, subjects with CD4 counts below 500 cells/ml had higher HIV-1 and lower HIV-2 levels. In plasma, subjects with CD4 counts above 500 cells/ml had mean HIV-1 plasma RNA viral loads 0.87 log 10 copies/ml higher (95% CI 0.35 to 1.38) than HIV-2, while among subjects with CD4 counts between 200 and 500 cells/ml or below 200 cells/ml, this difference increased to 4.28 and 4.35 log 10 copies/ml (95% CIs 2.51 to 6.04 and 2.67 to 6.04), respectively. Conclusion: Our data are consistent with the hypothesis that with decreasing CD4 counts and HIV disease progression, HIV-1 may outcompete HIV-2 in dually-infected individuals. This finding may help explain the differences in epidemiology between HIV-1 and HIV-2.

Iatrogenic Penile Amputation an Anatomy Lesson

A case report is presented of a young male patient seen at the University Teaching Hospital Lusak... more

Acceptability of neonatal male circumcision in Lusaka, Zambia

AIDS Care, 2011

Neonatal male circumcision (NMC) is being scaled up in Zambia and elsewhere in Southern Africa as... more Neonatal male circumcision (NMC) is being scaled up in Zambia and elsewhere in Southern Africa as a long-term HIV prevention strategy. We conducted 12 focus group discussions with 129 parents and grandparents in Lusaka, recruited from two sites providing free NMC services and information about NMC, to explore the acceptability of circumcising newborn boys. Most participants recognized the benefits of circumcision for HIV prevention, and the advantages of circumcising their children and grandchildren at a young age. Fear of negative outcomes, concerns about pain, and issues around cultural identity may challenge NMC uptake. To effectively promote the service, the upper age limit for NMC must be emphasized, and fathers must be targeted by messaging campaigns.

Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

The World Journal of Men's Health

Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assi... more Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. Materials and Methods: Materials and Methods: An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method.

Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

The World Journal of Men's Health

Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health... more Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations. Materials and Methods: Materials and Methods: Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus. Results: Results: The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing. Conclusions: Conclusions: This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians.

P-39 Exposure to occupational health hazards among Zambian workers: Results from the 2009 National Labour Force Survey

Data on occupational safety and health are scant in the southern Africa region. Hence the negativ... more Data on occupational safety and health are scant in the southern Africa region. Hence the negative impact of poor working conditions is unappreciated and the scientific basis for interventions and policy formulation is lacking. The objective of the study was to determine the prevalence and associated factors for occupational health hazards exposure in Zambia. We used data collected in the 2009 National Labour Force Survey. Unadjusted odds ratios (OR) and adjusted odds ratios (AOR) and their 95% confidence intervals (CI) were used to measure magnitudes of associations. Results from this study indicate Zambian workers are exposed to a broad range of occupational health hazards. The results of the present study could be useful for the formulation of a multi-sectoral approach aiming at the prevention and control of occupational hazards

Antisperm Antibody Testing: A Comprehensive Review of Its Role in the Management of Immunological Male Infertility and Results of a Global Survey of Clinical Practices

The World Journal of Men's Health

Antisperm antibodies (ASA), as a cause of male infertility, have been detected in infertile males... more Antisperm antibodies (ASA), as a cause of male infertility, have been detected in infertile males as early as 1954. Multiple causes of ASA production have been identified, and they are due to an abnormal exposure of mature germ cells to the immune system. ASA testing (with mixed anti-globulin reaction, and immunobead binding test) was described in the WHO manual 5th edition and is most recently listed among the extended semen tests in the WHO manual 6th edition. The relationship between ASA and infertility is somewhat complex. The presence of sperm agglutination, while insufficient to diagnose immunological infertility, may indicate the presence of ASA. However, ASA can also be present in the absence of any sperm agglutination. The andrological management of ASA depends on the etiology and individual practices of clinicians. In this article, we provide a comprehensive review of the causes of ASA production, its role in immunological male infertility, clinical indications of ASA testing, and the available therapeutic options. We also provide the details of laboratory procedures for assessment of ASA together with important measures for quality control. Additionally, laboratory and clinical scenarios are presented to guide the reader in the management of ASA and immunological male infertility. Furthermore, we report the results of a recent worldwide survey, conducted to gather information about clinical practices in the management of immunological male infertility.

Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations

The World Journal of Men's Health

Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performe... more Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performed to improve semen parameters and the chances of pregnancy. However, there is a lack of consensus about the diagnosis, indications for VR and its outcomes. The aim of this study was to explore global practice patterns on the management of varicocele in the context of male infertility. Materials and Methods: Materials and Methods: Sixty practicing urologists/andrologists from 23 countries contributed 382 multiple-choice-questions pertaining to varicocele management. These were condensed into an online questionnaire that was forwarded to clinicians involved in male infertility management through direct invitation. The results were analyzed for disagreement and agreement in practice patterns and, compared with the latest guidelines of international professional societies (American Urological Association [AUA], American Society for Reproductive Medicine [ASRM], and European Association of Urology [EAU]), and with evidence emerging from recent systematic reviews and meta-analyses. Additionally, an expert opinion on each topic was provided based on the consensus of 16 experts in the field. Results: Results: The questionnaire was answered by 574 clinicians from 59 countries. The majority of respondents were urologists/ uro-andrologists. A wide diversity of opinion was seen in every aspect of varicocele diagnosis, indications for repair, choice of technique, management of sub-clinical varicocele and the role of VR in azoospermia. A significant proportion of the responses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identified where no guidelines are available. Conclusions: Conclusions: This study is the largest global survey performed to date on the clinical management of varicocele for male infertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical practice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men.

Pre-operative bladder irrigation with 1% Povidone iodine in reducing open prostatectomy surgical site infection (SSI) at university teaching hospital, Lusaka

Medical journal of Zambia, 2013

Purpose : The aim of the study is to assess the effectiveness of using preoperative bladder irrig... more Purpose : The aim of the study is to assess the effectiveness of using preoperative bladder irrigation with 1% povidone iodine in reducing post transvesical prostatectomy surgical site infections. Study design: This was a prospective randomized cohort study with blinding of patients and outcome adjudicator regarding group assignments. Methodology : One hundred and thirty patients were recruited from the waiting list of Urology unit II in the department of surgery during the period between July 2011 to December 2012. The non-probability convenience sampling technique was used. Any consenting patient who presented to the department of surgery for open prostatectomy and fulfills the inclusion criteria was selected. The patients were randomly allocated to each of the two groups. Each group had 65 patients. Patients in the study group had their bladder irrigated with 1% 50cc povidoneiodine which was drained upon opening the bladder followed by enucleating the adenomatous prostate gland. ...

The epidemiology of cancers at Lusaka University Teaching Hospital in Zambia

East and Central African Journal of Surgery, 2008

Background : The pattern of malignancy in Zambia has not been well studied 1 . The high HIV preva... more Background : The pattern of malignancy in Zambia has not been well studied 1 . The high HIV prevalence of 16% is known both to have increased the number of HIV related cancers seen in Zambia as well as to have significantly changed the pattern of malignancies 2 . Methods : This was a retrospective study based on pathology reports of specimens reviewed at the University Teaching Hospital (UTH) pathology laboratory in Lusaka from January 1997 to December 2005. UTH is the main reference hospital in Zambia and has a catchment area of 1.3 million people 3 . Results : A total of 6672 pathology specimens were reported over this period. The male to female ratio was 1: 1.5. The most common cancer among men was Kaposi sarcoma which represented 20.9% of all male cancers seen. This was followed by cancer of the eye (14.3%), soft tissue sarcomas (10.9%) and cancer of the prostate (9.2%). The most common cancer in women was cancer of the cervix which represented 41.5% , followed by cancer of the ...

Urinary Retention due to Imperforate Hymen - A Case Series

Four cases are reported, of young girls in their early teens with urinary retention due to imperf... more Four cases are reported, of young girls in their early teens with urinary retention due to imperforate hymen. The girls presented to the University Teaching Hospital Lusaka Zambia with history of recurrent episodes of urinaryretentionduringtheirmenses.Uponexaminations they were found to have hematocolpos and thickened hymen, which ranged from complete to partially imperforate. Ultrasound studies showed evidence ofnonhomogenous echogenic masses suggestive of blood in the uterus. These patients were referred to the obstetrics department where the diagnosis was confirmed and subsequent excision of hymen with uterine evacuations was done. No subsequent episodes of urinary retention were observed. Urinary retention is the commonest cause of emergency admissioninurologyattheuniversityTeachingHospital Lusaka. It is more common in men than women. It is even uncommon in young teenage women. These case reports highlight the importance of high index of suspicion, careful examination and reprod...

Zambian Parents’ Perspectives on Early-Infant Versus Early-Adolescent Male Circumcision

AIDS and Behavior

The use of bladder voiding efficiency in assessing benign prostatic enlargement

African Journal of Urology

Background The management of benign prostatic enlargement (BPE) in low resource settings poses a ... more Background The management of benign prostatic enlargement (BPE) in low resource settings poses a major challenge in Africa. The objective of the study was to investigate the accuracy of Bladder Voiding Efficiency (BVE) to assess lower Urinary Tract Symptoms (LUTS) among BPE patients in a low resource setting. Methods From December 2017 to March 2018, patients with benign prostatic enlargement (BPE) and Lower Urinary Tract Symptoms (LUTS) were recruited into the study. The study was a prospective cross-sectional study. Participants had the International Prostate Symptom Score (IPSS) recorded followed by evaluation of their Bladder Voiding Efficiency (BVE). The BVE was calculated as the ratio of the volume of Urine voided over total volume of Urine in the bladder at the time of the void. The data were analysed to show the Sensitivity and Specificity of BVE in symptomatic LUTS. The Pearson correlation co-efficient between IPSS and BVE was analysed. Results The study recruited 94 partic...

The Accuracy of Bladder Voiding Efficiency to Predict the Severity of Lower Urinary Tract Symptoms in Benign Prostatic Enlargement Patients at Ndola Teaching Hospital, Ndola , Zambia

Background The management of Benign Prostatic Enlargement (BPE) in low resource settings poses a ... more Background The management of Benign Prostatic Enlargement (BPE) in low resource settings poses a major challenge in Africa. The objective of the study was to investigate the accuracy of Bladder Voiding Efficiency (BVE) to assess lower Urinary Tract Symptoms (LUTS) among BPE patients in a low resource setting. Methods From December 2017 to March 2018, patients with Benign Prostatic Enlargement (BPE) and Lower Urinary Tract Symptoms (LUTS) were recruited into the study. The study was a prospective cross-sectional study. Participants had the International Prostate Symptom Score (IPSS) recorded followed by evaluation of their Bladder Voiding Efficiency (BVE). The BVE was calculated as the ratio of the volume of Urine voided over total volume of Urine in the bladder at the time of the void. The data was analysed to show the Sensitivity and Specificity of BVE in symptomatic LUTS. The Pearson correlation co-efficient between IPSS and BVE was analysed. Results The study recruited 94 partici...

s response to reviews Title : Household Secondhand Smoke Exposure of Elementary Schoolchildren in Southern Taiwan and Factors Associated with their Confidence in Avoiding Exposure : a Cross-sectional Study

Ambiguous genitalia in rural Africa and the complexities of management:Which way forward?

East and Central African Journal of Surgery, 2008

Intersex disorders are amongst the most controversial conditions managed by doctors today. Althou... more Intersex disorders are amongst the most controversial conditions managed by doctors today. Although the diversity of their presentations demands broad classifications to help standardize management guidelines, each patient remains unique, requiring individualized care. The authors review the prevailing schools of thought on gender determination, assignment and re-assignment of intersex patients. The “liberal” views on sexuality, as espoused in current Western literature, vis-a-vis the “traditional” views of the average rural African community on sexuality are noted. The case histories of four patients highlight the diversity of presentations as well as the challenges in their management in a rural Kenyan hospital.

A single case report of Vulval Stenosis and its management

Clinical Case Reports and Reviews, 2018

Peer Review #2 of "Transcultural adaptation and validation of the questionnaire “Urgency, Weak stream, Incomplete emptying and Nocturia (UWIN)” for the Brazilian Portuguese (v0.1)

Lower urinary tract symptoms (LUTS) are common complaints in the adult male population and have a... more Lower urinary tract symptoms (LUTS) are common complaints in the adult male population and have a negative affect in the quality of life and represent an economic burden for the healthcare system worldwide. The International Prostatism Symptom Score (IPSS) is a validated tool for assessing these symptoms, but patients with low literacy may have difficulties comprehending and completing it accurately. The Urgency, Weak Stream, Incomplete Emptying, and Nocturia (UWIN) questionnaire was developed as a shorter tool in the assessment of LUTS to improve accuracy and minimize error. This study aimed at performing cross-cultural adaptation to Brazilian Portuguese and validation of UWIN questionnaire for patients with LUTS. The cross-cultural adaptation followed the steps of conceptual, item, semantic, operational, and pre-test equivalence to obtain the UWIN-Br version. The IPSS (gold standard) and UWIN-Br were coadministered, and information regarding the uroflowmetry examination was also recorded. We evaluated 306 men, median age 59 [52-66] years .There was a positive correlation r = 0.804 (p <0.001) between the total IPSS score and the total UWIN-Br score, as well as the quality of life question (r = 0.761) (p <0.001). The Bland-Altman plot showed good agreement between. Also, we observed that the maximum flow values decreased with the severity of the LUTS. UWIN-Br demonstrated excellent diagnostic accuracy in detecting the most severe cases. The area under the ROC curve was 89% [81-97%] 95% CI. 280 (91.5%) subjects completed the questionnaires without help, while 26 (8.5%) did so through an interview. The response time was 1.2 [1.0-1.5] min for UWIN-Br and 2.8 [2.2-3.4] min for IPSS (p <0.001). UWIN-Br presents satisfactory and similar psychometric properties to the IPSS in the evaluation of LUTS and quality of life and is suitable for use in both clinical practice and research in our country.

Acknowledgment of Reviewers, 2018

Journal of Global Oncology, 2018

It is with great appreciation that we acknowledge the following reviewers who have served our res... more

Variations in Origin and Course of the Right and Left Coronary Arteries in Autopsied Hearts at the University Teaching Hospital, Lusaka, Zambia

International Journal of Anatomy & Applied Physiology, 2016

Background: Coronary arteries play an important role in perfusion of the heart tissues. Variation... more Background: Coronary arteries play an important role in perfusion of the heart tissues. Variations or anomalies in coronary arteries may be asymptomatic while some can be symptomatic and even cause sudden death. Knowledge of coronary artery variations is important in diagnosis and treatment of cardiovascular diseases. Aim: To describe coronary artery anomalies and their incidence in autopsy cases. Materials and Methods: We dissected and grossly examined a total of 127 human hearts during autopsy to describe coronary artery variations in origin and course. Results: The incidence of coronary artery anomalies was found to be 4.72% (6/127; 1 female and 5 males). Among the coronary artery anomalies were: Absent left main coronary artery (LMCA) in 0.8% (1/127), origin of both the left and right coronary arteries from a common ostium located in the left aortic sinus in 0.8% (1/127), origin of both the left and right coronary arteries from a common trunk whose ostium was located in the right aortic sinus in 0.8% (1/127), origin of both the left and right coronary arteries from a common ostium located in the tubular part of the ascending aorta just above the right aortic sinus (RAS) in 0.8% (1/127), origin of the left coronary artery from a separate ostium in the RAS in 0.8% (1/127), origin of the right coronary artery from the sinutubular junction of the LAS in 0.8% (1/127) of the hearts. Conclusion: The incidence of coronary artery anomalies in autopsied hearts was found to be 4.72%. Knowledge of the normal and variant anatomy of coronary arteries is indispensable and imperative both in diagnosis, treatment and implementation of interventional measures.

Track C Epidemiology and Prevention Science

Journal of the International AIDS Society, 2012

Background: Dual infection with HIV-1 and HIV-2, which is not uncommon in West Africa, has import... more Background: Dual infection with HIV-1 and HIV-2, which is not uncommon in West Africa, has important implications for transmission, progression, and antiretroviral therapy. Few studies have examined HIV viral dynamics in this setting. Methods: We compared HIV-1 and HIV-2 viral loads from 65 dually infected, antiretroviral therapy-naïve Senegalese subjects. Participants provided demographic information and blood, oral fluid, and cervicovaginal lavage (CVL) or semen samples for virologic and immunologic testing. Associations between HIV-1 and HIV-2 levels in plasma, PBMC, oral and genital samples were assessed using linear regression models with generalized estimating equations to account for subjects with multiple samples over time. Results: In analyses adjusting for CD4 count, age, sex, and commercial sex work, HIV-1 RNA levels were significantly higher than HIV-2 levels in semen (b02.05 log 10 copies/ml, 95% CI 0.44 to 3.66), CVL (b 01.37, 95% CI 0.83 to 1.91), and oral fluids (b 01.93, 95% CI 1.56 to 2.30). HIV-1 and HIV-2 PBMC viral DNA loads were similar in those with normal immune function (CD4 counts above 500 cells/ml) (b 00.17 log 10 copies/mg of PBMC DNA, 95% CIÁ0.58 to 0.24), but compared to those with high CD4 counts, subjects with CD4 counts below 500 cells/ml had higher HIV-1 and lower HIV-2 levels. In plasma, subjects with CD4 counts above 500 cells/ml had mean HIV-1 plasma RNA viral loads 0.87 log 10 copies/ml higher (95% CI 0.35 to 1.38) than HIV-2, while among subjects with CD4 counts between 200 and 500 cells/ml or below 200 cells/ml, this difference increased to 4.28 and 4.35 log 10 copies/ml (95% CIs 2.51 to 6.04 and 2.67 to 6.04), respectively. Conclusion: Our data are consistent with the hypothesis that with decreasing CD4 counts and HIV disease progression, HIV-1 may outcompete HIV-2 in dually-infected individuals. This finding may help explain the differences in epidemiology between HIV-1 and HIV-2.

Iatrogenic Penile Amputation an Anatomy Lesson

A case report is presented of a young male patient seen at the University Teaching Hospital Lusak... more

Acceptability of neonatal male circumcision in Lusaka, Zambia

AIDS Care, 2011

Neonatal male circumcision (NMC) is being scaled up in Zambia and elsewhere in Southern Africa as... more Neonatal male circumcision (NMC) is being scaled up in Zambia and elsewhere in Southern Africa as a long-term HIV prevention strategy. We conducted 12 focus group discussions with 129 parents and grandparents in Lusaka, recruited from two sites providing free NMC services and information about NMC, to explore the acceptability of circumcising newborn boys. Most participants recognized the benefits of circumcision for HIV prevention, and the advantages of circumcising their children and grandchildren at a young age. Fear of negative outcomes, concerns about pain, and issues around cultural identity may challenge NMC uptake. To effectively promote the service, the upper age limit for NMC must be emphasized, and fathers must be targeted by messaging campaigns.

Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

The World Journal of Men's Health

Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assi... more Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. Materials and Methods: Materials and Methods: An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method.

Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

The World Journal of Men's Health

Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health... more Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations. Materials and Methods: Materials and Methods: Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus. Results: Results: The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing. Conclusions: Conclusions: This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians.

P-39 Exposure to occupational health hazards among Zambian workers: Results from the 2009 National Labour Force Survey

Data on occupational safety and health are scant in the southern Africa region. Hence the negativ... more Data on occupational safety and health are scant in the southern Africa region. Hence the negative impact of poor working conditions is unappreciated and the scientific basis for interventions and policy formulation is lacking. The objective of the study was to determine the prevalence and associated factors for occupational health hazards exposure in Zambia. We used data collected in the 2009 National Labour Force Survey. Unadjusted odds ratios (OR) and adjusted odds ratios (AOR) and their 95% confidence intervals (CI) were used to measure magnitudes of associations. Results from this study indicate Zambian workers are exposed to a broad range of occupational health hazards. The results of the present study could be useful for the formulation of a multi-sectoral approach aiming at the prevention and control of occupational hazards

Antisperm Antibody Testing: A Comprehensive Review of Its Role in the Management of Immunological Male Infertility and Results of a Global Survey of Clinical Practices

The World Journal of Men's Health

Antisperm antibodies (ASA), as a cause of male infertility, have been detected in infertile males... more Antisperm antibodies (ASA), as a cause of male infertility, have been detected in infertile males as early as 1954. Multiple causes of ASA production have been identified, and they are due to an abnormal exposure of mature germ cells to the immune system. ASA testing (with mixed anti-globulin reaction, and immunobead binding test) was described in the WHO manual 5th edition and is most recently listed among the extended semen tests in the WHO manual 6th edition. The relationship between ASA and infertility is somewhat complex. The presence of sperm agglutination, while insufficient to diagnose immunological infertility, may indicate the presence of ASA. However, ASA can also be present in the absence of any sperm agglutination. The andrological management of ASA depends on the etiology and individual practices of clinicians. In this article, we provide a comprehensive review of the causes of ASA production, its role in immunological male infertility, clinical indications of ASA testing, and the available therapeutic options. We also provide the details of laboratory procedures for assessment of ASA together with important measures for quality control. Additionally, laboratory and clinical scenarios are presented to guide the reader in the management of ASA and immunological male infertility. Furthermore, we report the results of a recent worldwide survey, conducted to gather information about clinical practices in the management of immunological male infertility.

Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations

The World Journal of Men's Health

Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performe... more Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performed to improve semen parameters and the chances of pregnancy. However, there is a lack of consensus about the diagnosis, indications for VR and its outcomes. The aim of this study was to explore global practice patterns on the management of varicocele in the context of male infertility. Materials and Methods: Materials and Methods: Sixty practicing urologists/andrologists from 23 countries contributed 382 multiple-choice-questions pertaining to varicocele management. These were condensed into an online questionnaire that was forwarded to clinicians involved in male infertility management through direct invitation. The results were analyzed for disagreement and agreement in practice patterns and, compared with the latest guidelines of international professional societies (American Urological Association [AUA], American Society for Reproductive Medicine [ASRM], and European Association of Urology [EAU]), and with evidence emerging from recent systematic reviews and meta-analyses. Additionally, an expert opinion on each topic was provided based on the consensus of 16 experts in the field. Results: Results: The questionnaire was answered by 574 clinicians from 59 countries. The majority of respondents were urologists/ uro-andrologists. A wide diversity of opinion was seen in every aspect of varicocele diagnosis, indications for repair, choice of technique, management of sub-clinical varicocele and the role of VR in azoospermia. A significant proportion of the responses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identified where no guidelines are available. Conclusions: Conclusions: This study is the largest global survey performed to date on the clinical management of varicocele for male infertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical practice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men.

Pre-operative bladder irrigation with 1% Povidone iodine in reducing open prostatectomy surgical site infection (SSI) at university teaching hospital, Lusaka

Medical journal of Zambia, 2013

Purpose : The aim of the study is to assess the effectiveness of using preoperative bladder irrig... more Purpose : The aim of the study is to assess the effectiveness of using preoperative bladder irrigation with 1% povidone iodine in reducing post transvesical prostatectomy surgical site infections. Study design: This was a prospective randomized cohort study with blinding of patients and outcome adjudicator regarding group assignments. Methodology : One hundred and thirty patients were recruited from the waiting list of Urology unit II in the department of surgery during the period between July 2011 to December 2012. The non-probability convenience sampling technique was used. Any consenting patient who presented to the department of surgery for open prostatectomy and fulfills the inclusion criteria was selected. The patients were randomly allocated to each of the two groups. Each group had 65 patients. Patients in the study group had their bladder irrigated with 1% 50cc povidoneiodine which was drained upon opening the bladder followed by enucleating the adenomatous prostate gland. ...

The epidemiology of cancers at Lusaka University Teaching Hospital in Zambia

East and Central African Journal of Surgery, 2008

Background : The pattern of malignancy in Zambia has not been well studied 1 . The high HIV preva... more Background : The pattern of malignancy in Zambia has not been well studied 1 . The high HIV prevalence of 16% is known both to have increased the number of HIV related cancers seen in Zambia as well as to have significantly changed the pattern of malignancies 2 . Methods : This was a retrospective study based on pathology reports of specimens reviewed at the University Teaching Hospital (UTH) pathology laboratory in Lusaka from January 1997 to December 2005. UTH is the main reference hospital in Zambia and has a catchment area of 1.3 million people 3 . Results : A total of 6672 pathology specimens were reported over this period. The male to female ratio was 1: 1.5. The most common cancer among men was Kaposi sarcoma which represented 20.9% of all male cancers seen. This was followed by cancer of the eye (14.3%), soft tissue sarcomas (10.9%) and cancer of the prostate (9.2%). The most common cancer in women was cancer of the cervix which represented 41.5% , followed by cancer of the ...