Anemia in Kashikishi, Zambia

Kelli Fast, BSN student

About Zambia Population: 16+ million (WHO, 2015)

Official language: English Spoken language in Kashikishi: Bemba

Literacy: males 71%, females 56% (CIA, 2015)

Life Expectancy: males 59, females 65 (WHO, 2015)

Neonatal, Infant, and Child <5 Mortality: 34, 70, and 119 per 1,000 live births (UNICEF)

Farming and fishing were the most common occupations in this rural area

Cars are a rarity, people walk to get everywhere they need to go

There was a large population of refugees from the Democratic Republic of Congo (13,000 and growing rapidly)

Course Objectives 1. Use evidence-based practices, health care technology, and effective communication

strategies to guide the essential public health interventions across the lifespan.

2. Use data from population assessments to identify the influences of the determinants

of health (environmental, social, political, legal-ethical, economic, behavioral, and

cultural) on delivery of care to diverse populations.

3. Assess the health status, health care access, and emergency preparedness needs of

the defined population.

4. Participate with healthcare providers and community leaders in the planning,

implementation, and evaluation of health interventions.

5. Collaborate with healthcare providers and community partners to promote clinical

prevention and population-focused health. Apply knowledge from nursing and related

arts and sciences to the care of selected community based aggregates.

Saint Paul’s Mission Hospital 200 beds, 150 typically in use

Employs 68 nurses, 4 doctors

Joined with Schools of Nursing & Midwifery

Male & Female Surgical Wards

Male & Female Medical Wards

Main Operating Theatre

Children’s Ward

Labor & Delivery, Postnatal Wards

Eye Clinic & Operating Theatre

ART Clinic

Left: The main operating theatre

Right: Mission, Vision, and Values on

display in Saint Paul’s School of

Nursing & Midwifery

Saint Paul’s Mission Hospital Through governmental aid, provides free services for people:

● Over age 65 & under age 5 ● Those too poor to pay (the majority of

patients)

And provides free services for these conditions:

● HIV/AIDS, TB, STDs ● Epidemics such as cholera ● Malnutrition ● Antenatal, delivery, & postnatal care ● Family planning ● Emergencies such as accidents

Top conditions treated at Saint Paul’s:

○ HIV/AIDS ○ Malaria ○ Malnutrition ○ Anemia ○ Respiratory diseases

(pneumonia, TB)

One room of the

children’s ward.

Children often sat

outside with their

mothers when

the weather was

nice.

Iron Deficiency Anemia

Early symptoms: fatigue, weakness, shortness of breath, pale conjunctiva

Anemia can have long-term effects on a child’s cognitive and physical development

Populations most at risk: people living in poverty, children, and women of childbearing age

(Huether, McCance, Brashers, & Rote, 2017)

Causes: chronic blood loss or dietary iron deficiency

Pathophysiology: decreased iron intake/production depletes iron stores, causing newly produced red blood cells to be smaller in size and carry a reduced amount of hemoglobin

Iron assists in immune function, and so anemia can put individuals at a higher risk for other illnesses, or exacerbate a current illness

Prevalence In Zambia, 53% of children under 5 & 30% of women of childbearing age are

affected by anemia (UNICEF)

Anemia often seen alongside malnutrition and malaria, two of the most

commonly treated illnesses in children at Saint Paul’s

Number of anemia cases treated by Saint Paul’s:

● 2014: 522

● 2015: 589

● 2016: 390

Interventions Individual Level Treat worm infestation or other underlying disease processes (malaria, malnutrition)

Folate and ferrous sulfate tablets

Blood transfusion in severe cases (Saint Paul’s had very limited access to blood)

Community Level

Malaria screening (a common cause of anemia)

Screening: Complete Blood Count

System Level

Nutrition education in primary schools, including foods high in iron, is a primary prevention strategy

Primary prevention: All children 6 months old to 5 years are given medications to prevent/treat parasitic worms, a common cause of anemia

Conclusion & Suggestions Anemia is a prevalent disease in the area that we visited,

especially in the pediatric population. It is caused by a

dietary iron deficiency or chronic blood loss.

The area we visited has an effective prevention program in

place by administering medications to children to prevent

and treat parasitic worm infestations.

Medications in children’s ward depleted and disorganized:

● If well-stocked and properly labelled, children would be

more likely to receive the necessary treatment

Most profound clinical experience: Caring for a patient with cobra bite

One of my fellow students and I cared for a patient

suffering from the effects of a cobra bite. We monitored

her condition with very limited resources and had to

track down a blood pressure cuff from another ward.

Later the healthcare team discovered the cobra had spit

venom into her eyes, which was the cause behind her

inability to open her eyes. Cobras are rarely

encountered in this area, and none of the staff had

witnessed the effects of a cobra bite before. We

developed a special bond with this patient and her

family, and came to visit them the next day. She was

continuing to improve, and we received an update after

our departure that she has recovered and is doing well.

Based on venom-spitting abilities

and geographic region, this may

have been the species that bit our

patient: Naja mossambica

Most profound cultural experience: Hospitality of the people

The people were so welcoming. Our hosts went

above and beyond to take care of us

“You are most welcome,” came to be our favorite

phrase

The children from the nearby village always wanted

to play and talk with us, and we became good friends

Alyssa, Alli, Kelli, and Ashley with

Sister Catherine Tente, one of our

kind hosts who also happens to be

the hospital administrator

Cheesin’ with some of

the special friends we

made during our stay

The breathtaking view

from outside our sleeping

quarters. The weather

ranges from a delightful

60-85 during the rainy

season

Us students with Julie (right), the hardworking and

kind-hearted housekeeper for the convent, and

Yev (middle), a volunteer doctor at the hospital

who placed a lot of trust in our clinical skills

Emmanuel (on right) invited us into his

home to meet his family before our

departure. He is a nursing professor and

coordinated our clinical experience in the

hospital and community

References Central Intelligence Agency. (2017). Zambia. Retrieved from

https://www.cia.gov/library/publications/the-world-factbook/geos/za.html

Huether, S., McCance, K., Brashers, V., & Rote, N. (2017). Understanding

physiology (6th ed.). St. Louis: Elsevier.

UNICEF. (2015). Zambia. Retrieved from

https://www.unicef.org/zambia/5109_8461.html

World Health Organization. (2015). Zambia. Retrieved from

http://www.who.int/countries/zmb/en/